Individual
ERIK S FOSSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, ROOM DG412, INDIANAPOLIS, IN 46202-1239
(317) 962-3886
(317) 963-5492
Mailing address
950 N. MERIDIAN STREET, STE 500, INDIANAPOLIS, IN 46204-3908
(317) 962-4942
(317) 962-4950
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01070394A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201101250
—
IN
Enumeration date
04/23/2010
Last updated
07/10/2013
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