Provider Demographics
NPI:1679591226
Name:GILBERTSON, ERIC K (DPM)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:K
Last Name:GILBERTSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 S POKEGAMA AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4289
Mailing Address - Country:US
Mailing Address - Phone:218-322-6085
Mailing Address - Fax:
Practice Address - Street 1:1920 S POKEGAMA AVE STE 103
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-4289
Practice Address - Country:US
Practice Address - Phone:218-322-6085
Practice Address - Fax:218-293-4520
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN727213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN470015500Medicaid
MN480000477Medicare PIN
MN470015500Medicaid