Provider Demographics
NPI:1174671739
Name:ERICKSON, TODD MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:MICHAEL
Last Name:ERICKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:TODD
Other - Middle Name:MICHAEL
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:BMDA - BANNER UNIVERSITY MEDICAL CENTER
Mailing Address - Street 2:925 E. MCDOWELL RD
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006
Mailing Address - Country:US
Mailing Address - Phone:602-521-3700
Mailing Address - Fax:602-521-3701
Practice Address - Street 1:BMDA - BANNER UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:925 E. MCDOWELL RD
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-521-3700
Practice Address - Fax:602-521-3701
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121466207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGG985ZMedicare PIN