Individual
DR. JAMES OWEN ERTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
333 CHESTNUT ST, SUITE 202, HINSDALE, IL 60521-3247
(630) 325-6880
(630) 325-5975
Mailing address
333 CHESTNUT ST, STE 202, HINSDALE, IL 60521-3247
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036043180
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0002215658
BCBSIL
IL
05
—
036043180
—
IL
01
—
1992762173
NPI
IL
01
—
313480
MEDICARE ID/TYPE UNSPECIF
IL
Enumeration date
04/30/2006
Last updated
06/29/2012
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