Healthcare Provider Details

I. General information

NPI: 1316421324
Provider Name (Legal Business Name): ERICA LESTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOHN H STROGER 1969 OGDEN AVE
CHICAGO IL
60612
US

IV. Provider business mailing address

850 S CLARK ST # C917
CHICAGO IL
60605-1782
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-6000
  • Fax:
Mailing address:
  • Phone: 312-539-4306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036.146268
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number036.146268
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: