Provider Demographics
NPI:1215627393
Name:CHRISTENSEN, ERIK KYLE
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:KYLE
Last Name:CHRISTENSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WAUCONDA
Mailing Address - State:IL
Mailing Address - Zip Code:60084-2453
Mailing Address - Country:US
Mailing Address - Phone:847-526-2821
Mailing Address - Fax:847-526-2836
Practice Address - Street 1:109 W LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WAUCONDA
Practice Address - State:IL
Practice Address - Zip Code:60084-2453
Practice Address - Country:US
Practice Address - Phone:847-526-2821
Practice Address - Fax:847-526-2836
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL60311041207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services