Provider Demographics
NPI:1912003013
Name:GRATKINS, LAWRENCE VINCENT (MD)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:VINCENT
Last Name:GRATKINS
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1300 FRANKLIN AVE
Mailing Address - Street 2:STE 270
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-3691
Mailing Address - Country:US
Mailing Address - Phone:309-454-1074
Mailing Address - Fax:309-454-3554
Practice Address - Street 1:1302 FRANKLIN AVE
Practice Address - Street 2:SUITE 2800
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3551
Practice Address - Country:US
Practice Address - Phone:309-454-1074
Practice Address - Fax:309-454-3554
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2024-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036059120207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036059120Medicaid
C37381Medicare UPIN