Individual provider Active NPI

Erik Mikkelsen, M.D.

  • Pediatric Critical Care Medicine Physician
  • Minneapolis, MN
National Provider Identifier
1467658989
Registry record updated Feb 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
53103 Issued in MN
Practice address
2530 Chicago Ave South
Suite 400
Minneapolis, MN 55404-4387
Phone
(612) 813-3300
Fax
(612) 813-3349
NPI assigned
Jun 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X 35.089605 OH
Pediatric Critical Care Medicine Physician 2080P0203X 53103 MN Primary

Addresses

Primary practice location

2530 Chicago Ave South
Suite 400
Minneapolis, MN 55404-4387

Mailing address

2530 Chicago Ave South
Suite 400
Minneapolis, MN 55404-4387
Phone (612) 813-3300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100805000620 MN Practitioner - Critical Care (Intensivists)Practitioner - Pediatric Medicine 8921196304 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
53103MNMDPediatric Critical Care Medicine Physician
35.089605OHMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
North Memorial Health Care Current Accepting new patients
Children'S Respiratory & Critical Care Specialists. P.a. CurrentSince Jul 1, 2010 Accepting new patients
North Memorial Health Care CurrentSince Apr 1, 2020 Accepting new patients
Gillette Children'S Specialty Healthcare CurrentSince Jan 9, 2018 Accepting new patients
North Memorial Health Care CurrentSince Apr 1, 2020 Accepting new patients
Gillette Children'S Specialty Healthcare CurrentSince Jan 9, 2018 Accepting new patients
Gillette Children'S Specialty Healthcare PastSince Jul 1, 2010 Accepting new patients
Gillette Children'S Specialty Healthcare Past Accepting new patients
Childrens Health Care Past Accepting new patients

Locations

9875 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-1000

2530 Chicago Ave
Ste 400
Minneapolis, MN 55404
Phone (612) 813-3300

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

200 University Ave E
Saint Paul, MN 55101
Phone (651) 291-2848

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298851200000",
    "number": "1467658989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2530 CHICAGO AVE SOUTH",
            "address_2": "SUITE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044387",
            "telephone_number": "612-813-3300",
            "fax_number": "612-813-3349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 CHICAGO AVE SOUTH",
            "address_2": "SUITE 400",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554044387",
            "telephone_number": "612-813-3300",
            "fax_number": "612-813-3349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKKELSEN",
        "first_name": "ERIK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-22",
        "last_updated": "2011-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "OH",
            "license": "35.089605",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "MN",
            "license": "53103",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.