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General NPI Number Information
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NPI Number | 1346746419
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Entity Type | Individual
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Provider Name | ERICA MARIE GRIMM DO
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Gender | Female
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 3412 OFFICE PARK DR
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City | MARION
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State | IL
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Zip | 62959-6477
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Country | US
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Telephone | 618-993-0404
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Fax | 618-993-1717
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Provider Business Mailing Address
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Address Line | 21819 ENYENHAUSEN RD
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City | CREAL SPRINGS
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State | IL
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Zip | 62922-2423
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Country | US
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Telephone | 315-708-2283
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 036176517
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2105
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License Number State | NE
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