Provider Demographics
NPI:1891969796
Name:ERROL C. BAPTIST M.D.
Entity Type:Organization
Organization Name:ERROL C. BAPTIST M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERROL
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:BAPTIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-397-2400
Mailing Address - Street 1:461 N MULFORD RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5190
Mailing Address - Country:US
Mailing Address - Phone:815-397-2400
Mailing Address - Fax:815-397-1879
Practice Address - Street 1:461 N MULFORD RD
Practice Address - Street 2:SUITE 4
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5190
Practice Address - Country:US
Practice Address - Phone:815-397-2400
Practice Address - Fax:815-397-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360555992080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC37328Medicare UPIN