Provider Demographics
NPI:1174580054
Name:SUGARMAN, ERIC (AT,C)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:SUGARMAN
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 VIKING DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3825
Mailing Address - Country:US
Mailing Address - Phone:952-828-6523
Mailing Address - Fax:952-828-6555
Practice Address - Street 1:9520 VIKING DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3825
Practice Address - Country:US
Practice Address - Phone:952-828-6523
Practice Address - Fax:952-828-6555
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART001077A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist