Provider Demographics
NPI:1356625362
Name:SLOCUM, ERICH N (DO)
Entity type:Individual
Prefix:
First Name:ERICH
Middle Name:N
Last Name:SLOCUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:611 W. PARK ST.
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2500
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:1540 E. GROVE STREET
Practice Address - Street 2:
Practice Address - City:RANTOUL
Practice Address - State:IL
Practice Address - Zip Code:61866-2736
Practice Address - Country:US
Practice Address - Phone:217-893-7700
Practice Address - Fax:217-893-7801
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2014-05-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036.131467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF40098409Medicare UPIN