NPI Code Details Logo

NPI 1215918230

NPI 1215918230 : ERICA J KLAW PA-C : CHICAGO, IL

=====================================================
General NPI Number Information
=====================================================
    NPI Number           |    1215918230
-----------------------------------------------------
    Entity Type          |    Individual 
-----------------------------------------------------
    Provider Name        |    ERICA J KLAW PA-C
-----------------------------------------------------
    Gender               |    Female 
-----------------------------------------------------

=====================================================
Dates
=====================================================
    Enumeration Date     |    11/08/2005
-----------------------------------------------------
    Last Update Date     |    09/02/2025
-----------------------------------------------------

=====================================================
Provider Practice Location Address
=====================================================
    Address Line         |    4025 N WESTERN AVE BLDG E 
-----------------------------------------------------
    City                 |    CHICAGO
-----------------------------------------------------
    State                |    IL
-----------------------------------------------------
    Zip                  |    60618-3726
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    773-725-7700
-----------------------------------------------------
    Fax                  |    773-279-6504
-----------------------------------------------------

=====================================================
Provider Business Mailing Address
=====================================================
    Address Line         |    29373 NETWORK PL 
-----------------------------------------------------
    City                 |    CHICAGO
-----------------------------------------------------
    State                |    IL
-----------------------------------------------------
    Zip                  |    60673-1293
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    847-390-5900
-----------------------------------------------------
    Fax                  |    
-----------------------------------------------------

=====================================================
Authorized Official
=====================================================
    Title or Position    |    
-----------------------------------------------------
    Name                 |        
-----------------------------------------------------
    Credential           |    
-----------------------------------------------------
    Telephone            |    
-----------------------------------------------------

=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
    Taxonomy Code        |    363AM0700X
-----------------------------------------------------
    Taxonomy Name        |    Medical Physician Assistant
-----------------------------------------------------
    License Number       |    085001472
-----------------------------------------------------
    License Number State |    IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
    Taxonomy Code        |    363A00000X
-----------------------------------------------------
    Taxonomy Name        |    Physician Assistant
-----------------------------------------------------
    License Number       |    085-001472
-----------------------------------------------------
    License Number State |    IL
-----------------------------------------------------



                        

Copyright © 2007-2025 Data Labs Health. All rights reserved.