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:
Health care specialties
| Specialty | Code | License # | 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 6 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1386962207 | NPPES |
| Illinois | MEDICAID | 036143979 |
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