Basic Information
| Provider Information | |||||||||
| NPI: | 1851442487 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ERICKSON HEALTH MEDICAL GROUP OF MI, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5525 RESEARCH PARK DR | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212284664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4104022258 | ||||||||
| FaxNumber: | 4102047279 | ||||||||
| Practice Location | |||||||||
| Address1: | 41100 FOX RUN | ||||||||
| Address2: | |||||||||
| City: | NOVI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483774804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2486688650 | ||||||||
| FaxNumber: | 2486688651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/12/2007 | ||||||||
| LastUpdateDate: | 09/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | NARRETT | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | VP AND CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4104022257 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | 6141430001 | 01 | DME | OTHER |