Healthcare Provider Details

I. General information

NPI: 1093158792
Provider Name (Legal Business Name): ERIK LEE MYERS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAPT JAMES A LOVELL FHCC
NORTH CHICAGO IL
60088-8980
US

IV. Provider business mailing address

CAPT JAMES A LOVELL FHCC
NORTH CHICAGO IL
60088-8980
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-6755
  • Fax:
Mailing address:
  • Phone: 847-688-6755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: