Provider Demographics
NPI:1225013253
Name:ERIKSEN, BARTLETT (MD)
Entity Type:Individual
Prefix:
First Name:BARTLETT
Middle Name:
Last Name:ERIKSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:MN
Mailing Address - Zip Code:56031-4575
Mailing Address - Country:US
Mailing Address - Phone:507-238-8555
Mailing Address - Fax:
Practice Address - Street 1:800 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:MN
Practice Address - Zip Code:56031-4575
Practice Address - Country:US
Practice Address - Phone:507-238-8555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN21403207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN116212Medicaid
IA959478Medicaid
MNA020OtherCHAMPUS
MN22787OtherSIOUX VALLEY
MN559215OtherARAZ
MNHP29870OtherHEALTH PARTNERS
MN5T420EROtherBCBS
MNMH9041000378OtherPPO
MN01-13166OtherMEDICA
MN5T420EROtherBCBS/MEDICARE SUPPLEMENT
MN5T420ERMedicaid
MN80013655Medicare ID - Type UnspecifiedMEDICARE
IA959478Medicaid
MN5T420ERMedicaid
MN116212Medicaid