Provider Demographics
NPI:1124245410
Name:GRANDIA, LONN J (MD)
Entity type:Individual
Prefix:DR
First Name:LONN
Middle Name:J
Last Name:GRANDIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LONN
Other - Middle Name:
Other - Last Name:GRANDIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:GENERAL DELIVERY
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:IL
Mailing Address - Zip Code:62047-9999
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:0224 RENDLEMAN HALL
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62026-1055
Practice Address - Country:US
Practice Address - Phone:618-650-2842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist