Provider Demographics
NPI:1760476535
Name:ERICKSON, ROBERT C (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:C
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 S ADAMS RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-7005
Mailing Address - Country:US
Mailing Address - Phone:248-644-8060
Mailing Address - Fax:248-644-5081
Practice Address - Street 1:800 S ADAMS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-7005
Practice Address - Country:US
Practice Address - Phone:248-644-8060
Practice Address - Fax:248-644-5081
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIRE058028207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F37296004OtherRAILROAD MEDICARE
381867275OtherHARRINGTON BENEFITS
381867275OtherPPOM
MI3359311Medicaid
MI180F372960OtherBLUE CARE NETWORK
MI0F37296OtherBCBSM
381867275OtherUNITED HEALTHCARE
G12736OtherHAP
381867275OtherAETNA
381867275OtherCIGNA
381867275OtherWPS TRICARE FOR LIFE
C5033OtherMCARE
381867275OtherGREAT LAKES
381867275OtherCIGNA
381867275OtherHARRINGTON BENEFITS
381867275OtherWPS TRICARE FOR LIFE