Basic Information
| Provider Information | |||||||||
| NPI: | 1891969796 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ERROL C. BAPTIST M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 461 N MULFORD RD | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611075190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153972400 | ||||||||
| FaxNumber: | 8153971879 | ||||||||
| Practice Location | |||||||||
| Address1: | 461 N MULFORD RD | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611075190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153972400 | ||||||||
| FaxNumber: | 8153971879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2008 | ||||||||
| LastUpdateDate: | 04/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | BAPTIST | ||||||||
| AuthorizedOfficialFirstName: | ERROL | ||||||||
| AuthorizedOfficialMiddleName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialTitleorPosition: | PEDIATRICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8153972400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | 036055599 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
No ID Information.