Provider Demographics
NPI:1679689582
Name:ERDMANN, BRIAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:ERDMANN
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 1:580 SHEPARD ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-3552
Mailing Address - Country:US
Mailing Address - Phone:715-420-1831
Mailing Address - Fax:715-420-1829
Practice Address - Street 1:580 SHEPARD ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-3552
Practice Address - Country:US
Practice Address - Phone:715-420-1831
Practice Address - Fax:715-420-1829
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39040207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI64730OtherSECURITY HEALTH PLAN
WI32479700Medicaid
WI32479700Medicaid
WI32479700Medicaid