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1619931185

NPI Code Detail

MEDICARE: DR. KEITH J ERICKSON MD

MEDICARE: DR. KEITH J ERICKSON MD

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	2084P0800X	Psychiatry Physician	36144	MN
2	2084P0800X	Psychiatry Physician	6210	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4T606ER	OTHER	MN	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	12327	OTHER	ND	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619931185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEITH J ERICKSON MD

Provider Business Mailing Address
First Line	:	1900 SILVER LAKE RD NW STE 110
Second Line	:
City	:	NEW BRIGHTON
State	:	MN
Zip	:	55112-1789
Country	:	US
Telephone Number	:	844-374-8893
Fax Number	:	651-628-0411

Provider Business Practice Location Address
First Line	:	13100 WAYZATA BLVD STE 200
Second Line	:
City	:	MINNETONKA
State	:	MN
Zip	:	55305-1810
Country	:	US
Telephone Number	:	952-206-2040
Fax Number	:	952-206-2041

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

Provider Enumeration Date	:	04/13/2006
Last Update Date	:	05/31/2023

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Directions to “ DR. KEITH J ERICKSON MD” Practice Location

Language	Start Address	Practice Location

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