Healthcare Provider Details

I. General information

NPI: 1982601324
Provider Name (Legal Business Name): ERIKS A USIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 MENTOR AVE STE 100
MENTOR OH
44060-4496
US

IV. Provider business mailing address

9000 MENTOR AVE STE 100
MENTOR OH
44060-4496
US

V. Phone/Fax

Practice location:
  • Phone: 440-974-4470
  • Fax: 440-974-4173
Mailing address:
  • Phone: 440-974-4470
  • Fax: 440-974-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35074903U
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: