Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 036075093 | IL |
NPI | 1023019643 |
---|---|
Provider Name | Dr. Richard E. Erickson |
First Address | Carol Stream, IL 60188-2402 |
Second Address | Carol Stream, IL 60188-2402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2005 |
Last Update Date | 01/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E43667 | (02) | IL |