Kenneth J Grayer Jr.
Individual provider Active NPI Driver · Libertyville, IL
NPI 1740884279 · NPPES record last updated Aug 16, 2021
Key facts
- NPI
- 1740884279
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Driver 172A00000X
- Practice address
- 520 E Lincoln Ave
Libertyville, IL 60048-2923 - Phone
- (662) 346-3883
- NPI assigned
- Nov 25, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Graybridge Health, NFP | Current |
Accepting new patients | |
| Medical Logistics LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | Yes |
Addresses
Primary practice location
520 E Lincoln Ave
Libertyville, IL 60048-2923
Mailing address
520 E Lincoln Ave
Libertyville, IL 60048-2923
Phone (662) 346-3883
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | https://www.medlogisticsllc.com | Direct |
Other providers in Libertyville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 16, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.