MEDICARE: ERICH N SLOCUM D.O.

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	207Q00000X	Family Medicine Physician	036.131467	IL

General Provider Information

NPI Number	:	1356625362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICH N SLOCUM D.O.

Provider Business Mailing Address
First Line	:	611 W. PARK ST.
Second Line	:	BWPC
City	:	URBANA
State	:	IL
Zip	:	61801-2500
Country	:	US
Telephone Number	:	217-383-6792
Fax Number	:	217-383-4752

Provider Business Practice Location Address
First Line	:	1540 E. GROVE STREET
Second Line	:
City	:	RANTOUL
State	:	IL
Zip	:	61866-2736
Country	:	US
Telephone Number	:	217-893-7700
Fax Number	:	217-893-7801

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

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	05/13/2014

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