1437120888 NPI number — ERIK D DANIELS MD

Table of content: ERIK D DANIELS MD (NPI 1437120888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437120888 NPI number — ERIK D DANIELS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DANIELS
Provider First Name:
ERIK
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437120888
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 MEMORIAL DR
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
ALTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62002-6723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-463-2390
Provider Business Mailing Address Fax Number:
618-433-7952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11125 DUNN RD
Provider Second Line Business Practice Location Address:
STE 304
Provider Business Practice Location Address City Name:
ST LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-355-1166
Provider Business Practice Location Address Fax Number:
314-355-9179
Provider Enumeration Date:
02/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  MD111769 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: 036093413 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 208546309 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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