Healthcare Provider Details

I. General information

NPI: 1760860829
Provider Name (Legal Business Name): ERICA LOPATA KLEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2015
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 W DEMPSTER ST
PARK RIDGE IL
60068-1143
US

IV. Provider business mailing address

225 E CHICAGO AVE # 9
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-8236
  • Fax:
Mailing address:
  • Phone: 312-227-3484
  • Fax: 312-227-9783

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 StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number036-151606
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number125.067700
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036151606
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: