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NPI Code Detail

MEDICARE: ERICKSON HEALTH MEDICAL GROUP OF ILLINOIS PC

MEDICARE: ERICKSON HEALTH MEDICAL GROUP OF ILLINOIS PC
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
1207Q00000XFamily Medicine Physician
2363LA2200XAdult Health Nurse Practitioner
3364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist
4207QG0300XGeriatric Medicine (Family Medicine) Physician
5207RG0300XGeriatric Medicine (Internal Medicine) Physician
6363LG0600XGerontology Nurse Practitioner
7364SG0600XGerontology Clinical Nurse Specialist
8207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1487663126
Entity Type Code : Organization
Provider Name (Legal Business Name) : ERICKSON HEALTH MEDICAL GROUP OF ILLINOIS PC
Provider Business Mailing Address
First Line : 5525 RESEARCH PARK DR
Second Line : 4TH FLOOR
City : BALTIMORE
State : MD
Zip : 21228-4664
Country : US
Telephone Number : 410-402-2258
Fax Number : 410-204-7279
Provider Business Practice Location Address
First Line : 2255 MONARCH DR
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-4164
Country : US
Telephone Number : 630-300-1300
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MATTHEW J NARRETT
Credential : MD
Telephone Number : 410-402-2257
Provider Enumeration Date : 08/05/2006
Last Update Date : 09/01/2011

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