Provider Demographics
NPI:1629004254
Name:KORPI, ERIK CHRISTIAN (NP)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:CHRISTIAN
Last Name:KORPI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:STE 190
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-5406
Mailing Address - Country:US
Mailing Address - Phone:906-485-2716
Mailing Address - Fax:906-485-2725
Practice Address - Street 1:901 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-1367
Practice Address - Country:US
Practice Address - Phone:906-485-2716
Practice Address - Fax:906-485-2725
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704197310363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5008754600OtherBLUE CROSS BLUE SHIELD
MI1629004254Medicaid
500030419OtherRAILROAD MEDICARE
MI4435098Medicaid
MI4435098Medicaid
MI1629004254Medicaid
MIP29950031Medicare PIN