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NPI Code Detail

MEDICARE: ERIK DAVID ENGLEHART M.D.

MEDICARE: ERIK DAVID ENGLEHART 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
1207Q00000XFamily Medicine Physician036-107672IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3DC4641OTHERILRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21932033OTHERILBLUE CHOICE
480-0101372OTHERILCHAMPUS TRICARE
580-0101372OTHERILPREFERRED PLAN PPO
680-0101372OTHERILUNITED HEALTHCARE
71932033OTHERILBC/BS PPO
880-0101372OTHERILCATERPILLAR
980-0101372OTHERILPHCS

General Provider Information

NPI Number : 1679581367
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIK DAVID ENGLEHART M.D.
Provider Business Mailing Address
First Line : 1310 N MAIN ST STE 200
Second Line :
City : SANDWICH
State : IL
Zip : 60548-1397
Country : US
Telephone Number : 815-786-7150
Fax Number : 815-786-3785
Provider Business Practice Location Address
First Line : 1310 N MAIN ST STE 200
Second Line :
City : SANDWICH
State : IL
Zip : 60548-1397
Country : US
Telephone Number : 815-786-7150
Fax Number : 815-786-3785
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2006
Last Update Date : 03/27/2020

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Directions to “ ERIK DAVID ENGLEHART M.D.” Practice Location

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