MEDICARE: DR. MELVIN EHRHARDT M.D.

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
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05721369	OTHER	IL	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154358380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELVIN EHRHARDT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 131
Second Line	:
City	:	COLLISON
State	:	IL
Zip	:	61831-0131
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	VIRGINIA & FRANKLIN STREETS
Second Line	:
City	:	NORMAL
State	:	IL
Zip	:	61761
Country	:	US
Telephone Number	:	309-827-4321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/08/2007

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