Basic Information
| Provider Information | |||||||||
| NPI: | 1205091485 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ERICKSON | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2310 HOLMES ST | ||||||||
| Address2: | STE 800 | ||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641082602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162182523 | ||||||||
| FaxNumber: | 8162856923 | ||||||||
| Practice Location | |||||||||
| Address1: | 2401 GILLHAM RD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641084619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8162343000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2008 | ||||||||
| LastUpdateDate: | 04/20/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2011020141 | MO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 04-35925 | KS | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 04-35925 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 2011020141 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 2011020141 | MO | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.