Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 5101013947 | MI |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 5101013947 | MI |
NPI | 1104864560 |
---|---|
Provider Name | Erik Hedlund |
First Address | Grand Rapids, MI 49525-6406 |
Second Address | Grand Rapids, MI 49525-6406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 03/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D14869120 | MEDICARE PTAN (01) | MI |
H94940 | (02) | |
OD14869 | (02) | MI |
PO1223799 | MEDICARE RAILROAD (01) | MI |