Provider Demographics
NPI:1679770150
Name:MCCOMB, ERIN (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:MCCOMB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-695-5753
Mailing Address - Fax:312-695-5645
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 800
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-695-5753
Practice Address - Fax:312-695-5645
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361136022085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A997680Medicaid
CAWA99768BMedicare PIN
CA00A997680Medicaid