Provider Demographics
NPI:1225010119
Name:GEURTS, GERARD (PA-C)
Entity type:Individual
Prefix:MR
First Name:GERARD
Middle Name:
Last Name:GEURTS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BLANCHARD CIR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2037
Mailing Address - Country:US
Mailing Address - Phone:630-653-0848
Mailing Address - Fax:630-653-0988
Practice Address - Street 1:7 BLANCHARD CIR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2037
Practice Address - Country:US
Practice Address - Phone:630-926-4337
Practice Address - Fax:630-653-0988
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL550894537OtherTAX ID
IL920540OtherMEDICARE PTAN (GROUP)
K03094OtherMCR
ILF400104135OtherMEDICARE PTAN (INDIVIDUAL)
K18826OtherMCR ID
IL920540OtherMEDICARE PTAN (GROUP)
K03094OtherMCR