Provider Demographics
NPI:1942569678
Name:BIRK, ERIN LAIS
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LAIS
Last Name:BIRK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N. HAMILTON ST
Mailing Address - Street 2:APT 124
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-5304
Mailing Address - Country:US
Mailing Address - Phone:214-205-2685
Mailing Address - Fax:
Practice Address - Street 1:303 N HAMILTON ST
Practice Address - Street 2:APT 124
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-5310
Practice Address - Country:US
Practice Address - Phone:214-205-2685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist