Provider Demographics
NPI:1427101922
Name:KING, ERIC D (PA-C)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:D
Last Name:KING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1765 N ELSTON AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-1501
Mailing Address - Country:US
Mailing Address - Phone:773-276-1100
Mailing Address - Fax:773-276-1102
Practice Address - Street 1:1765 N ELSTON AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-1501
Practice Address - Country:US
Practice Address - Phone:773-276-1100
Practice Address - Fax:773-276-1102
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085002875363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical