Individual
DR. DAVID LAMONT ERICSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1162 W MAPLE AVE, MUNDELEIN, IL 60060-1438
(847) 367-2400
Mailing address
1162 W MAPLE AVE, MUNDELEIN, IL 60060-1438
(847) 367-2400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036117087
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
820800
MEDICARE PTAN(GROUP)
IL
01
—
K36911
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
02/09/2007
Last updated
04/02/2021
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