Basic Information
| Provider Information | |||||||||
| NPI: | 1487071940 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRAHAM | ||||||||
| FirstName: | HANNAH | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 REMINGTON BLVD. | ||||||||
| Address2: | SUITE 100 CREDENTIALING DEPARTMENT | ||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309142898 | ||||||||
| FaxNumber: | 6309142469 | ||||||||
| Practice Location | |||||||||
| Address1: | 7447 W TALCOTT AVE STE 121 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606313712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7739903900 | ||||||||
| FaxNumber: | 7739903929 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036142910 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036142910 | 01 | IL | STATE LICENSE | OTHER |