Provider Demographics
NPI:1477583425
Name:ERDRICH, ANGELA MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARY
Last Name:ERDRICH
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:PO BOX 3955
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-0955
Mailing Address - Country:US
Mailing Address - Phone:612-377-5632
Mailing Address - Fax:
Practice Address - Street 1:1315 E 24TH STREET
Practice Address - Street 2:INDIAN HEALTH BOARD OF MINNEAPOLIS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404
Practice Address - Country:US
Practice Address - Phone:612-721-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52658208000000X
WI39226-020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G60395Medicare UPIN