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General NPI Number Information
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NPI Number | 1003700238
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Entity Type | Individual
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Provider Name | ERICA MA
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Gender |
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Dates
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Enumeration Date | 06/03/2025
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 1 GENESYS PKWY
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City | GRAND BLANC
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State | MI
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Zip | 48439-8065
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Country | US
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Telephone | 810-606-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 4153 MONARCH AVE
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City | CANTON
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State | MI
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Zip | 48188-7207
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5151017601
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License Number State | MI
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