Provider Demographics
NPI:1346899630
Name:MORSE, JEREMY GANTZ (PHD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:GANTZ
Last Name:MORSE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 W BUENA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1694
Mailing Address - Country:US
Mailing Address - Phone:773-236-7504
Mailing Address - Fax:
Practice Address - Street 1:815 W BUENA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1694
Practice Address - Country:US
Practice Address - Phone:773-236-7504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist