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Individual

GERALD GANTT JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
840 S WOOD ST STE 518E, CHICAGO, IL 60612
(312) 996-2061
Mailing address
840 S WOOD ST STE 518E, CHICAGO, IL 60612-4325

Taxonomy

Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
036143979
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036143979
IL
Enumeration date
05/17/2010
Last updated
08/23/2018
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