Healthcare Provider Details

I. General information

NPI: 1487634069
Provider Name (Legal Business Name): JOEL T ERSKIN SCD PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 N CAMPUS DR SUITE 500
GARDEN CITY KS
67846-6329
US

IV. Provider business mailing address

816 N CAMPUS DR SUITE 500
GARDEN CITY KS
67846-6329
US

V. Phone/Fax

Practice location:
  • Phone: 620-805-5162
  • Fax: 620-805-5183
Mailing address:
  • Phone: 620-805-5162
  • Fax: 620-805-5183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1500265
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: