Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 66103 | WI |
N | 208200000X | Surgeon | 131491 | CA |
N | 208600000X | Surgeon | 131491 | CA |
NPI | 1194967000 |
---|---|
Provider Name | Dr. Calvin Eriksen |
First Address | Milwaukee, WI 53226-3522 |
Second Address | Milwaukee, WI 53226-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2009 |
Last Update Date | 09/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1194967000 | (05) | WI |