Provider Demographics
NPI:1902396757
Name:ERSKINE, ALYSSA MICHELLE (DO)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MICHELLE
Last Name:ERSKINE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:574-647-1088
Mailing Address - Fax:
Practice Address - Street 1:850 S HEALTH PKWY
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-8358
Practice Address - Country:US
Practice Address - Phone:269-279-5240
Practice Address - Fax:269-273-9060
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02007019A207R00000X
MI5101026055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1902396757Medicaid
IN300070503Medicaid
IN261970190OtherMEDICARE
MIMI7819124OtherMEDICARE