Provider Demographics
NPI:1508989716
Name:ERDMAN, BOYD ERIC (MD)
Entity Type:Individual
Prefix:
First Name:BOYD
Middle Name:ERIC
Last Name:ERDMAN
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 1:2275 DEMING WAY
Mailing Address - Street 2:SUITE 280
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5527
Mailing Address - Country:US
Mailing Address - Phone:608-831-7003
Mailing Address - Fax:608-831-7044
Practice Address - Street 1:2275 DEMING WAY
Practice Address - Street 2:SUITE 280
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-5527
Practice Address - Country:US
Practice Address - Phone:608-831-7003
Practice Address - Fax:608-831-7044
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40938-020202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIG99308Medicare UPIN