Healthcare Provider Details

I. General information

NPI: 1508989716
Provider Name (Legal Business Name): BOYD ERIC ERDMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E MAIN ST STE 115
WAUNAKEE WI
53597-1274
US

IV. Provider business mailing address

114 E MAIN ST STE 115
WAUNAKEE WI
53597-1274
US

V. Phone/Fax

Practice location:
  • Phone: 608-831-7003
  • Fax: 608-831-7044
Mailing address:
  • Phone: 608-831-7003
  • Fax: 608-831-7044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number40938-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: