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General NPI Number Information
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NPI Number | 1225307853
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Entity Type | Individual
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Provider Name | ERIC MINDE M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 12/28/2011
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Provider Practice Location Address
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Address Line | 4300 N. MARINE DR. 903
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City | CHICAGO
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State | IL
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Zip | 60613-5802
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Country | US
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Telephone | 773-549-7013
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Fax | 773-549-7013
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Provider Business Mailing Address
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Address Line | 4300 N. MARINE DR. 903
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City | CHICAGO
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State | IL
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Zip | 60613-5802
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Country | US
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Telephone | 773-549-7013
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Fax | 773-549-7013
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 036101415
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MD014307E
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License Number State | PA
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