Gantt, Gerald

Gantt, Gerald is an individual health care provider with primary practice located at 840 S Wood St Ste 518E , Chicago IL 60612. He recently has only one registered license in Allopathic & Osteopathic Physicians / Colon & Rectal Surgery, which is considered as his primary health care specialty. Gantt, Gerald can be contacted via phone (312) 996-2061.

Contact Information

Primary practice address
840 S Wood St Ste 518E Chicago IL 60612
Phone: (312) 996-2061
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X 036143979 Illinois

Profile Details

NPI number 1386962207
LBN Legal business name Gantt, Gerald
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2010
Last updated Aug 23rd, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386962207 NPPES
Illinois MEDICAID 036143979

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