Healthcare Provider Details

I. General information

NPI: 1740643428
Provider Name (Legal Business Name): ERIC OHLSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2799 W GRAND BLVD HENRY FORD HOSPITAL MEDICAL EDUCATION DEPARTMENT
DETROIT MI
48202-2608
US

IV. Provider business mailing address

2799 W GRAND BLVD HENRY FORD HOSPITAL MEDICAL EDUCATION DEPARTMENT
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 313-916-2600
  • Fax:
Mailing address:
  • Phone: 313-916-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2019-0511
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: