Provider Demographics
NPI:1225307853
Name:MINDE, ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:MINDE
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 1:4300 N. MARINE DR.
Mailing Address - Street 2:903
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5802
Mailing Address - Country:US
Mailing Address - Phone:773-549-7013
Mailing Address - Fax:773-549-7013
Practice Address - Street 1:4300 N. MARINE DR.
Practice Address - Street 2:903
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5802
Practice Address - Country:US
Practice Address - Phone:773-549-7013
Practice Address - Fax:773-549-7013
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101415208100000X
PAMD014307E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation