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NPI Code Detail

MEDICARE: ERIK J EKSTROM MD

MEDICARE: ERIK J EKSTROM 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
1208100000XPhysical Medicine & Rehabilitation Physician40685MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710917471
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIK J EKSTROM MD
Provider Business Mailing Address
First Line : 710 COMMERCE DR STE 200
Second Line :
City : WOODBURY
State : MN
Zip : 55125-4925
Country : US
Telephone Number : 651-968-5201
Fax Number : 651-968-5904
Provider Business Practice Location Address
First Line : 15700 37TH AVE N STE 150
Second Line :
City : PLYMOUTH
State : MN
Zip : 55446-3675
Country : US
Telephone Number : 651-968-5201
Fax Number : 651-968-5904
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2006
Last Update Date : 07/21/2022

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