Individual
JEREMY LARVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
259 E ERIE ST FL 13, CHICAGO, IL 60611-3926
(312) 695-6800
(312) 695-2772
Mailing address
6269 KARL RD, COLUMBUS, OH 43229-2128
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085006107
IL
Other
Enumeration date
05/14/2007
Last updated
08/03/2017
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