Provider Demographics
NPI:1548219611
Name:ERICKSON, LISA (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2828 CHICAGO AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1544
Mailing Address - Country:US
Mailing Address - Phone:612-863-5390
Mailing Address - Fax:612-863-2697
Practice Address - Street 1:2828 CHICAGO AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1544
Practice Address - Country:US
Practice Address - Phone:612-863-5390
Practice Address - Fax:612-863-2697
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN28924207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7400041 MPLSOtherMEDICA
MNHP20734OtherHEALTH PARTNERS
MN1012114OtherPREFERRED ONE
MN64G44EROtherBLUE CROSS
MN87446OtherAMERICAS PIO