Provider Demographics
NPI:1427033497
Name:CONSTANCE, ERIK J (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:J
Last Name:CONSTANCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19636
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9636
Mailing Address - Country:US
Mailing Address - Phone:217-545-0182
Mailing Address - Fax:217-545-4735
Practice Address - Street 1:751 N RUTLEDGE ST
Practice Address - Street 2:STE 1100
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4909
Practice Address - Country:US
Practice Address - Phone:217-545-0182
Practice Address - Fax:217-545-4735
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-081514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081514Medicaid
E83618Medicare UPIN
IL036081514Medicaid