Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 036110654 | IL |
NPI | 1013021286 |
---|---|
Provider Name | Dr. Erica Dayan |
First Address | Lake Forest, IL 60045-1674 |
Second Address | Highland Park, IL 60035-2400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 07/01/2013 |