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NPI Code Detail

MEDICARE: ERICA JAIME DR

MEDICARE: ERICA JAIME DR
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramIL

General Provider Information

NPI Number : 1063343234
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA JAIME DR
Provider Business Mailing Address
First Line : 30 SANDHURST RD
Second Line :
City : MUNDELEIN
State : IL
Zip : 60060-3237
Country : US
Telephone Number : 224-565-8554
Fax Number :
Provider Business Practice Location Address
First Line : 17 N DEARBORN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60602-4310
Country : US
Telephone Number : 224-565-8554
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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Directions to “ ERICA JAIME DR” Practice Location

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