Provider Demographics
NPI:1487841193
Name:GRAYS MEDICAL CENTER
Entity Type:Organization
Organization Name:GRAYS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:PLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD,
Authorized Official - Phone:708-345-5273
Mailing Address - Street 1:1835 BROADWAY ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-2040
Mailing Address - Country:US
Mailing Address - Phone:708-345-5272
Mailing Address - Fax:708-345-5282
Practice Address - Street 1:1835 BROADWAY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-2040
Practice Address - Country:US
Practice Address - Phone:708-345-5282
Practice Address - Fax:708-345-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210451Medicare PIN