Provider Demographics
NPI:1942239447
Name:HARTL, ERICA E (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:E
Last Name:HARTL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 E GOLF RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-5700
Mailing Address - Country:US
Mailing Address - Phone:847-640-9180
Mailing Address - Fax:847-640-4450
Practice Address - Street 1:825 E GOLF RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-5700
Practice Address - Country:US
Practice Address - Phone:847-640-9180
Practice Address - Fax:847-640-4450
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036103206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103206Medicaid
L86016Medicare ID - Type Unspecified