Healthcare Provider Details

I. General information

NPI: 1093106700
Provider Name (Legal Business Name): ERIK JOHNSON SIMON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 SILVER CROSS BLVD STE 240
NEW LENOX IL
60451-9528
US

IV. Provider business mailing address

POB 7132960
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 815-485-4458
  • Fax: 815-485-4463
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number036-155187
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: