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General NPI Number Information
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NPI Number | 1558356410
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Entity Type | Individual
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Provider Name | QUENBY LEA ERICKSON D.O
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Gender | Female
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 737 N MICHIGAN AVE STE 900
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City | CHICAGO
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State | IL
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Zip | 60611-6600
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Country | US
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Telephone | 312-300-6858
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Fax |
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Provider Business Mailing Address
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Address Line | 737 N MICHIGAN AVE STE 900
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City | CHICAGO
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State | IL
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Zip | 60611-6600
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Country | US
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Telephone | 312-300-6858
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 02002378A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 036-114774
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License Number State | IL
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