MEDICARE: ERLAND INTERNAL MEDICINE, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	M6886	ID

General Provider Information

NPI Number	:	1104177757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERLAND INTERNAL MEDICINE, PC

Provider Business Mailing Address
First Line	:	3667 N LOCUST GROVE RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-5924
Country	:	US
Telephone Number	:	208-939-9090
Fax Number	:	208-939-9911

Provider Business Practice Location Address
First Line	:	3667 N LOCUST GROVE RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-5924
Country	:	US
Telephone Number	:	208-939-9911
Fax Number	:	208-939-9911

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. KERILYNN ERLAND
Credential	:	MD
Telephone Number	:	541-602-7999

Provider Enumeration Date	:	09/23/2012
Last Update Date	:	02/27/2021

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