Provider Demographics
NPI:1396078176
Name:GRANT, JENNIFER L (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:GRANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:COATS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1000 CENTRAL ST STE 800
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1780
Mailing Address - Country:US
Mailing Address - Phone:847-657-5959
Mailing Address - Fax:847-657-5764
Practice Address - Street 1:1000 CENTRAL ST STE 800
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1780
Practice Address - Country:US
Practice Address - Phone:847-657-5959
Practice Address - Fax:847-657-5764
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130141207R00000X, 207RI0200X
IL036.130141207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine