MEDICARE: ERIC EVAN KIRKSSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	56002	WI
2	208100000X	Physical Medicine & Rehabilitation Physician	51158	MN

General Provider Information

NPI Number	:	1184870255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC EVAN KIRKSSON MD

Provider Business Mailing Address
First Line	:	1321 PAYNE AVE UNIT 2
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-3433
Country	:	US
Telephone Number	:	651-371-4880
Fax Number	:	651-371-4881

Provider Business Practice Location Address
First Line	:	1321 PAYNE AVE UNIT 2
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-3433
Country	:	US
Telephone Number	:	651-371-4880
Fax Number	:	651-371-4881

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	01/12/2023

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