Provider Demographics
NPI:1851452312
Name:IVERSEN, ERIK J (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:J
Last Name:IVERSEN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1222 TROTWOOD AVE
Mailing Address - Street 2:SUITE 605
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-6436
Mailing Address - Country:US
Mailing Address - Phone:931-490-7775
Mailing Address - Fax:931-490-7797
Practice Address - Street 1:1222 TROTWOOD AVE
Practice Address - Street 2:SUITE 605
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6436
Practice Address - Country:US
Practice Address - Phone:931-490-7775
Practice Address - Fax:931-490-7797
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301109965207RC0200X
TN37662207RC0200X, 207RP1001X
FLME129911207RC0200X
WV29004207RC0200X
WI66387207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1851452312Medicaid
TN4081378OtherBCBS TN
TNP00129206OtherRAILROAD MEDICARE
TN3725122Medicaid
TNDB8051OtherRR MEDICARE GROUP
TN3889995Medicaid
WI1851452312Medicaid
WIK400359316Medicare PIN