Provider Demographics
NPI:1043233471
Name:BAPTIST, ERROL CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:ERROL
Middle Name:CHRISTOPHER
Last Name:BAPTIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 78866
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53278-8866
Mailing Address - Country:US
Mailing Address - Phone:779-696-7150
Mailing Address - Fax:
Practice Address - Street 1:461 N MULFORD RD
Practice Address - Street 2:SUITE # 4
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5190
Practice Address - Country:US
Practice Address - Phone:779-696-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0555992080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-055599Medicaid