Provider Demographics
NPI:1679581367
Name:ENGLEHART, ERIK DAVID (MD)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:DAVID
Last Name:ENGLEHART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 N MAIN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-1397
Mailing Address - Country:US
Mailing Address - Phone:815-786-7150
Mailing Address - Fax:815-786-3785
Practice Address - Street 1:1310 N MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-1397
Practice Address - Country:US
Practice Address - Phone:815-786-7150
Practice Address - Fax:815-786-3785
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-107672207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-107672Medicaid
IL1932033OtherBLUE CHOICE
ILDC4641OtherRAILROAD MEDICARE
IL80-0101372OtherCHAMPUS TRICARE
IL80-0101372OtherPREFERRED PLAN PPO
IL80-0101372OtherUNITED HEALTHCARE
IL1932033OtherBC/BS PPO
IL80-0101372OtherCATERPILLAR
IL80-0101372OtherPHCS
ILH75046Medicare UPIN
ILK07722Medicare PIN