Provider Demographics
NPI:1215918230
Name:KLAW, ERICA J (PA-C)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:J
Last Name:KLAW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2701 PATRIOT BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-8039
Mailing Address - Country:US
Mailing Address - Phone:847-475-2273
Mailing Address - Fax:847-998-9833
Practice Address - Street 1:2701 PATRIOT BLVD STE 110
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-8039
Practice Address - Country:US
Practice Address - Phone:847-475-2273
Practice Address - Fax:847-998-9833
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001472363AM0700X
IL085-001472363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
319790002Medicare PIN