Provider Demographics
NPI:1841279833
Name:STORVICK, ERIC J (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:STORVICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 8674
Mailing Address - Street 2:1230 E MAIN ST MANKATO CLINIC LTD
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1230 E MAIN STREET
Practice Address - Street 2:MANKATO CLINIC AT MAIN STREET
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56002-8674
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN36201207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0401913OtherMEDICA MN
121152OtherUCARE MN
MN415863600Medicaid
41084933956001C033OtherCHAMPUS
IA938472Medicaid
110103563OtherRR MEDICARE
2M646STOtherBCBS MN
NA2951023861OtherPREFERRED ONE MN
HP25686OtherHEALTH PARTNERS MN
887698OtherAMERICAS PPO MN
MN119001065Medicare PIN
110103563OtherRR MEDICARE