Provider Demographics
NPI:1619078482
Name:STROM, ERIK GORDON (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:GORDON
Last Name:STROM
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 1:1 VETERANS DR
Mailing Address - Street 2:DEPT. OF IMAGING
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2309
Mailing Address - Country:US
Mailing Address - Phone:612-467-2935
Mailing Address - Fax:612-467-2636
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:DEPT. OF IMAGING
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-2935
Practice Address - Fax:612-467-2636
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN198312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C338230Medicaid
A35389Medicare UPIN
CA00C338230Medicaid