Provider Demographics
NPI:1740486489
Name:DOMINIAK, ERIN BETH (MD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:BETH
Last Name:DOMINIAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1610 LUTHER LN
Mailing Address - Street 2:AMG - ADULT DOWN SYNDROME CENTER
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1243
Mailing Address - Country:US
Mailing Address - Phone:847-318-2303
Mailing Address - Fax:
Practice Address - Street 1:1610 LUTHER LN
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1243
Practice Address - Country:US
Practice Address - Phone:847-318-2303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-118378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-118378OtherPHYSICIAN LICENSE