Provider Demographics
NPI:1457841405
Name:ERICKSON, BROOKE (MD)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:ERICKSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4316 RICE LAKE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2885
Mailing Address - Country:US
Mailing Address - Phone:218-740-7400
Mailing Address - Fax:
Practice Address - Street 1:4316 RICE LAKE RD STE 101
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2885
Practice Address - Country:US
Practice Address - Phone:218-740-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ66951207N00000X
MN74881207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology