Provider Demographics
NPI:1689757684
Name:ERB, KENT WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:WILLIAM
Last Name:ERB
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 775985
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5985
Mailing Address - Country:US
Mailing Address - Phone:317-770-6900
Mailing Address - Fax:317-770-6911
Practice Address - Street 1:611 E 10TH ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:IN
Practice Address - Zip Code:46069-9106
Practice Address - Country:US
Practice Address - Phone:317-758-4477
Practice Address - Fax:317-758-0936
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100235900Medicaid
080158247Medicare PIN
IN100235900Medicaid
INB29537Medicare UPIN
IN151560LLLMedicare PIN
INM400049616Medicare PIN