Provider Demographics
NPI:1245768951
Name:DEPREKEL, ERIN NICOLE (DO)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:NICOLE
Last Name:DEPREKEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 TIMBER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-9419
Mailing Address - Country:US
Mailing Address - Phone:517-294-6803
Mailing Address - Fax:
Practice Address - Street 1:1711 S STEPHENSON AVE STE 210
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3649
Practice Address - Country:US
Practice Address - Phone:517-205-3998
Practice Address - Fax:517-205-7050
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101026481204D00000X, 207Q00000X
MI5101023100390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program