Healthcare Provider Details

I. General information

NPI: 1679591226
Provider Name (Legal Business Name): ERIC K GILBERTSON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 S POKEGAMA AVE STE 103
GRAND RAPIDS MN
55744-4289
US

IV. Provider business mailing address

1920 S POKEGAMA AVE STE 103
GRAND RAPIDS MN
55744-4289
US

V. Phone/Fax

Practice location:
  • Phone: 218-322-6085
  • Fax: 218-293-4520
Mailing address:
  • Phone: 218-322-6085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number727
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: