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General NPI Number Information
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NPI Number | 1255794533
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Entity Type | Individual
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Provider Name | JONATHAN ERICKSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2016
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | N2950 STATE ROAD 67
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City | LAKE GENEVA
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State | WI
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Zip | 53147-2655
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Country | US
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Telephone | 262-245-0535
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Fax | 262-245-2248
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Provider Business Mailing Address
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Address Line | N2950 STATE ROAD 67
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City | LAKE GENEVA
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State | WI
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Zip | 53147-2655
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Country | US
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Telephone | 262-245-0535
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Fax | 262-245-2248
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | A173174
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 68109-20
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | A173174
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 71727
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License Number State | MN
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 68109
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License Number State | WI
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