Individual
DR. KEITH J ERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13100 WAYZATA BLVD STE 200, MINNETONKA, MN 55305-1810
(952) 206-2040
(952) 206-2041
Mailing address
1900 SILVER LAKE RD NW STE 110, NEW BRIGHTON, MN 55112-1789
(844) 374-8893
(651) 628-0411
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
36144
MN
2084P0800X
Psychiatry Physician
6210
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103765000
—
MN
01
—
12327
BLUE CROSS BLUE SHIELD
ND
05
—
17911
—
ND
01
—
4T606ER
BLUE CROSS BLUE SHIELD
MN
Enumeration date
04/13/2006
Last updated
05/31/2023
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