Provider Demographics
NPI:1740594431
Name:ERICKSON HEALTH MEDICAL GROUP OF ILLINOIS, PC
Entity Type:Organization
Organization Name:ERICKSON HEALTH MEDICAL GROUP OF ILLINOIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:NARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-402-2261
Mailing Address - Street 1:5525 RESEARCH PARK DR
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4664
Mailing Address - Country:US
Mailing Address - Phone:410-402-2258
Mailing Address - Fax:410-204-7279
Practice Address - Street 1:2255 ERICKSON DR
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-4164
Practice Address - Country:US
Practice Address - Phone:630-300-1125
Practice Address - Fax:630-300-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6447870002OtherDME