Individual
JEFFREY LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
251 E HURON ST, CHICAGO, IL 60611-2908
(312) 695-8182
Mailing address
201 E CHESTNUT ST APT 11F, CHICAGO, IL 60611-7377
(914) 960-6649
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
125.079332
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/17/2018
Last updated
06/20/2022
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