Provider Demographics
NPI:1073809737
Name:WASSERLAUF, JEREMIAH (MD, MS)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:
Last Name:WASSERLAUF
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9650 GROSS POINT RD STE 4900
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-5080
Mailing Address - Country:US
Mailing Address - Phone:847-864-3278
Mailing Address - Fax:847-676-1727
Practice Address - Street 1:9650 GROSS POINT RD STE 4900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-5080
Practice Address - Country:US
Practice Address - Phone:847-864-3278
Practice Address - Fax:847-676-1727
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036134026207RC0000X, 207RC0001X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease