Ericson, David Lamont

Ericson, David Lamont is an individual health care provider with primary practice located at 1162 W Maple Ave , Mundelein IL 60060-1438. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Ericson, David Lamont can be contacted via phone (847) 367-2400.

Contact Information

Primary practice address
1162 W Maple Ave Mundelein IL 60060-1438
Phone: (847) 367-2400
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036117087 Illinois

Profile Details

NPI number 1417098690
LBN Legal business name Ericson, David Lamont
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 9th, 2007
Last updated Apr 2nd, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417098690 NPPES
Illinois Other 820800 MEDICARE PTAN(GROUP)
Illinois Other K36911 MEDICARE PTAN(GROUP)

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