Individual
MR. ERICH D. MAHALKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CFA
Contact information
Practice address
420 N IL ROUTE 31, CRYSTAL LAKE, IL 60012
(815) 356-5200
(815) 356-5262
Mailing address
420 N IL ROUTE 31, CRYSTAL LAKE, IL 60012-3711
(815) 356-5200
(815) 356-5262
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
238.000417
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
117716
NATIONAL CERTIFICATION AS A SURGICAL TECHNOLOGIST/FIRST ASSISTANT
—
01
—
238.000417
REGISTERED SURGICAL ASSISTANT LICENSE
IL
Enumeration date
04/03/2012
Last updated
05/15/2018
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