1528421336 NPI number — ERIKA ILKANICH

Table of content: ANNA LOUISE ENG PT (NPI 1811101793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528421336 NPI number — ERIKA ILKANICH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ILKANICH
Provider First Name:
ERIKA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

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:
1528421336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7901 DILEY RD
Provider Second Line Business Mailing Address:
STE 255
Provider Business Mailing Address City Name:
CANAL WINCHESTER
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43110-9612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-834-2995
Provider Business Mailing Address Fax Number:
614-834-3533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7901 DILEY RD
Provider Second Line Business Practice Location Address:
STE 255
Provider Business Practice Location Address City Name:
CANAL WINCHESTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43110-9612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-834-2995
Provider Business Practice Location Address Fax Number:
614-834-3533
Provider Enumeration Date:
03/30/2016

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: 225100000X , with the licence number:  9591 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: PT016677 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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