Most Relevant Information
Provider Data
| NPI Number: | 1003021916 |
| Provider Name: | JEREMY LARVA PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 085006107 |
Most Important Dates
| Enumeration Date: | 05/14/2007 |
| Last Updated: | 08/03/2017 |
Provider Practice Location
259 E ERIE ST FL 13
CHICAGO
IL
606113926
Practice Location Phone/Fax
| Phone: | 3126956800 |
| Fax: | 3126952772 |
Provider Mailing Location
6269 KARL RD
COLUMBUS
OH
432292128
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |