MEDICARE: KEVIN ERDMAN PA-C

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	363AM0700X	Medical Physician Assistant	1161-023	WI
2	363A00000X	Physician Assistant	1161-23	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275723157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN ERDMAN PA-C

Provider Business Mailing Address
First Line	:	25320 75TH ST
Second Line	:
City	:	SALEM
State	:	WI
Zip	:	53168-9684
Country	:	US
Telephone Number	:	262-843-2336
Fax Number	:

Provider Business Practice Location Address
First Line	:	25320 75TH ST
Second Line	:
City	:	SALEM
State	:	WI
Zip	:	53168-9684
Country	:	US
Telephone Number	:	262-843-2336
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	04/27/2023

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