Provider Demographics
NPI:1093703365
Name:JEAN-LOUIS, GERTY (MD)
Entity Type:Individual
Prefix:
First Name:GERTY
Middle Name:
Last Name:JEAN-LOUIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 DEMPSTER ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1846
Mailing Address - Country:US
Mailing Address - Phone:847-470-9911
Mailing Address - Fax:
Practice Address - Street 1:5301 DEMPSTER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1846
Practice Address - Country:US
Practice Address - Phone:847-470-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74280207P00000X, 208M00000X
FLPA9102677363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400011804Medicare PIN