Healthcare Provider Details

I. General information

NPI: 1003485376
Provider Name (Legal Business Name): MICRO NEURO SPINE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2021
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1406 W CHICAGO AVE
CHICAGO IL
60642-5479
US

IV. Provider business mailing address

1406 W CHICAGO AVE
CHICAGO IL
60642-5479
US

V. Phone/Fax

Practice location:
  • Phone: 312-804-5652
  • Fax: 312-264-0993
Mailing address:
  • Phone: 312-804-5652
  • Fax: 312-264-0993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT KEITH ERICKSON
Title or Position: OWNER
Credential: MD
Phone: 312-804-5652