Provider Demographics
NPI:1801873294
Name:ERDAHL, JAMES
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ERDAHL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6405 FRANCE AVENUE S
Mailing Address - Street 2:STE W200
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435
Mailing Address - Country:US
Mailing Address - Phone:952-924-9005
Mailing Address - Fax:952-924-0330
Practice Address - Street 1:6405 FRANCE AVENUE
Practice Address - Street 2:STE W200
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435
Practice Address - Country:US
Practice Address - Phone:952-924-9005
Practice Address - Fax:952-924-0330
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25848207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA95015Medicare UPIN