Gravnet L.L.C
Family Medicine, Adolescent Medicine in Champaign, IL. Organization (NPI-2).
NPI number1831965409
StatusActive
Last updated in NPPESNov 27, 2023
Details
- NPI
- 1831965409
- Entity type
- Organization (NPI-2)
- Legal business name
- Gravnet L.L.C
- Organization subpart
- No
- Enumeration date
- Nov 27, 2023
- Certification date
- Nov 26, 2023
- Last updated
- Nov 27, 2023
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207QA0000X | Family Medicine, Adolescent Medicine | – | – | Yes |
| 207QA0505X | Family Medicine, Adult Medicine | – | – |
Practice location
2608 Bershire DrChampaign, IL 61821-5703
Phone 630-481-6399
Mailing address
2608 Bershire DrChampaign, IL 61821-5703
Phone 630-481-6399
Authorized official
Jay Patel
Medical Director
6304816399
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