Provider Demographics
NPI:1437120888
Name:DANIELS, ERIK D (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:D
Last Name:DANIELS
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 1:2 MEMORIAL DR
Mailing Address - Street 2:STE 201
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6723
Mailing Address - Country:US
Mailing Address - Phone:618-463-2390
Mailing Address - Fax:618-433-7952
Practice Address - Street 1:11125 DUNN RD
Practice Address - Street 2:STE 304
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136
Practice Address - Country:US
Practice Address - Phone:314-355-1166
Practice Address - Fax:314-355-9179
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD111769207RN0300X
IL036093413207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208546309Medicaid
G36325Medicare UPIN
MO208546309Medicaid