MEDICARE: DR. ERIK DENNIS MCCLURE 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	208100000X	Physical Medicine & Rehabilitation Physician	125-051161	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01251475	OTHER	IL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036.127953	OTHER	IL	LICENSE NO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396992236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIK DENNIS MCCLURE M.D.

Provider Business Mailing Address
First Line	:	401 N MICHIGAN AVE
Second Line	:	SUITE 1200
City	:	CHICAGO
State	:	IL
Zip	:	60611-4264
Country	:	US
Telephone Number	:	312-635-0973
Fax Number	:	813-290-9691

Provider Business Practice Location Address
First Line	:	255 W 69TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60621-3767
Country	:	US
Telephone Number	:	773-224-5900
Fax Number	:	773-224-7157

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

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	10/29/2015

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Directions to “ DR. ERIK DENNIS MCCLURE M.D.” Practice Location

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