Provider Demographics
NPI:1093712481
Name:ENGELSTEIN, ERICA D (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:D
Last Name:ENGELSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7447 W TALCOTT AVE STE 222
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3713
Mailing Address - Country:US
Mailing Address - Phone:773-326-2244
Mailing Address - Fax:773-326-2253
Practice Address - Street 1:7447 W TALCOTT AVE STE 222
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3713
Practice Address - Country:US
Practice Address - Phone:773-326-2244
Practice Address - Fax:773-326-2253
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103567207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103567Medicaid
ILG17177Medicare UPIN
IL036103567Medicaid
IL210591Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER