Provider Demographics
NPI:1649478678
Name:KING, ERIN LEE (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LEE
Last Name:KING
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 1:1602 21ST ST
Mailing Address - Street 2:
Mailing Address - City:GRANITE CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62040-5397
Mailing Address - Country:US
Mailing Address - Phone:618-451-5722
Mailing Address - Fax:314-814-8542
Practice Address - Street 1:1602 21ST ST
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-5397
Practice Address - Country:US
Practice Address - Phone:618-451-5722
Practice Address - Fax:618-451-9092
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011001618207VG0400X
IL036117422207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology