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NPI Code Detail

MEDICARE: ERIN LEE KING M.D.

MEDICARE: ERIN LEE KING M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207VG0400XGynecology Physician2011001618MO
2207VG0400XGynecology Physician036117422IL

General Provider Information

NPI Number : 1649478678
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIN LEE KING M.D.
Provider Business Mailing Address
First Line : 1602 21ST ST
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-5397
Country : US
Telephone Number : 618-451-5722
Fax Number : 314-814-8542
Provider Business Practice Location Address
First Line : 1602 21ST ST
Second Line :
City : GRANITE CITY
State : IL
Zip : 62040-5397
Country : US
Telephone Number : 618-451-5722
Fax Number : 618-451-9092
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2007
Last Update Date : 03/19/2021

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