Healthcare Provider Details

I. General information

NPI: 1760476535
Provider Name (Legal Business Name): ROBERT C. ERICKSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S ADAMS RD SUITE 201
BIRMINGHAM MI
48009-7005
US

IV. Provider business mailing address

800 S ADAMS RD SUITE 201
BIRMINGHAM MI
48009-7005
US

V. Phone/Fax

Practice location:
  • Phone: 248-644-8060
  • Fax: 248-644-5081
Mailing address:
  • Phone: 248-644-8060
  • Fax: 248-644-5081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberRE058028
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: