Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | KE011553 | MI |
N | 1223S0112X | Oral and Maxillofacial Surgeon | KE011553 | MI |
N | 1223X0008X | Oral and Maxillofacial Radiology | KE011553 | MI |
NPI | 1568486769 |
---|---|
Provider Name | Dr. Kim L Erickson |
First Address | Grand Rapids, MI 49546-3665 |
Second Address | Grand Rapids, MI 49546-3665 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T82820 | (02) | MI |