Basic Information
| Provider Information | |||||||||
| NPI: | 1245768951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEPREKEL | ||||||||
| FirstName: | ERIN | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1283 TIMBER RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | IRON MOUNTAIN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498019419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172946803 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1711 S STEPHENSON AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | IRON MOUNTAIN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498013649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172053998 | ||||||||
| FaxNumber: | 5172057050 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204D00000X | 5101026481 | MI | N | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | 390200000X | 5101023100 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 5101026481 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.