Healthcare Provider Details

I. General information

NPI: 1346746419
Provider Name (Legal Business Name): ERICA MARIE GRIMM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERICA MARIE WHITE

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 OFFICE PARK DR
MARION IL
62959-6477
US

IV. Provider business mailing address

21819 ENYENHAUSEN RD
CREAL SPRINGS IL
62922-2423
US

V. Phone/Fax

Practice location:
  • Phone: 618-993-0404
  • Fax: 618-993-1717
Mailing address:
  • Phone: 315-708-2283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036176517
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2105
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: