Healthcare Provider Details

I. General information

NPI: 1992090930
Provider Name (Legal Business Name): JILL LARSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST SUITE 1350
CHICAGO IL
60611-2927
US

IV. Provider business mailing address

676 N SAINT CLAIR ST STE 1350
CHICAGO IL
60611-4795
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-4444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberCDR.0006576
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number125059136
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: