Basic Information
| Provider Information | |||||||||
| NPI: | 1851512909 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERAZO | ||||||||
| FirstName: | LILIANA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1509 | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601211509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2242384160 | ||||||||
| FaxNumber: | 8477830599 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 PENNY AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | EAST DUNDEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601181431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474280915 | ||||||||
| FaxNumber: | 8475519509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 09/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036.118714 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04532482 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER | 036118714 | 05 | IL | MEDICAID | 05300348 | 01 | IL | IL HEALTH CONNECT | OTHER |