Healthcare Provider Details

I. General information

NPI: 1912121237
Provider Name (Legal Business Name): MICHELE CHRISTINE ERICKSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 PLAZA DR
EAGAN MN
55122-2979
US

IV. Provider business mailing address

6330 UPPER 179TH ST
LAKEVILLE MN
55044-3419
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-4001
  • Fax:
Mailing address:
  • Phone: 952-953-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number48359
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: