Individual
DR. KAVITA K ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
800 E CARPENTER ST, SPRINGFIELD, IL 62769-9701
(217) 544-6464
Mailing address
111 OAKWOOD RD, EAST PEORIA, IL 61611-1853
(309) 740-4272
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
01056693A
IN
2085R0202X
Diagnostic Radiology Physician
Primary
036-145004
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200402500
—
IN
Enumeration date
09/16/2006
Last updated
01/11/2024
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