Basic Information
| Provider Information | |||||||||
| NPI: | 1215391099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ORTMAN | ||||||||
| FirstName: | GRACE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 KISH HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | DEKALB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601159602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157667334 | ||||||||
| FaxNumber: | 8157669768 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 KISH HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | DEKALB | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601159602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157667334 | ||||||||
| FaxNumber: | 8157669768 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2016 | ||||||||
| LastUpdateDate: | 07/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207P00000X | 036151500 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.