Provider Demographics
NPI:1659345445
Name:ERPELDING, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:ERPELDING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:MC21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-6181
Mailing Address - Fax:763-287-5019
Practice Address - Street 1:640 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:952-883-6181
Practice Address - Fax:763-287-5019
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2008-09-07
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Provider Licenses
StateLicense IDTaxonomies
MN39030207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN21471310QMedicaid
MN21471310QMedicaid
F96755Medicare UPIN