Healthcare Provider Details

I. General information

NPI: 1225048804
Provider Name (Legal Business Name): ROBERT KEITH ERICKSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
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 Number036-066065
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: