Healthcare Provider Details

I. General information

NPI: 1174671739
Provider Name (Legal Business Name): TODD MICHAEL ERICKSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. TODD MICHAEL ERICKSON

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BMDA - BANNER UNIVERSITY MEDICAL CENTER 925 E. MCDOWELL RD
PHOENIX AZ
85006
US

IV. Provider business mailing address

BMDA - BANNER UNIVERSITY MEDICAL CENTER 925 E. MCDOWELL RD
PHOENIX AZ
85006
US

V. Phone/Fax

Practice location:
  • Phone: 602-521-3700
  • Fax: 602-521-3701
Mailing address:
  • Phone: 602-521-3700
  • Fax: 602-521-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA121466
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: