Provider Demographics
NPI:1225035314
Name:MESERVEY, JEROME TREVOR (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:TREVOR
Last Name:MESERVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1345 WILEY RD
Mailing Address - Street 2:STE 117
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4356
Mailing Address - Country:US
Mailing Address - Phone:847-884-9440
Mailing Address - Fax:847-884-8051
Practice Address - Street 1:1345 WILEY RD
Practice Address - Street 2:STE 117
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4356
Practice Address - Country:US
Practice Address - Phone:847-884-9440
Practice Address - Fax:847-884-8051
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics