Provider Demographics
NPI:1306813092
Name:NUSSBAUM, ERIC S (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:S
Last Name:NUSSBAUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1950 NORTHWESTERN AVE S STE 102
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7615
Mailing Address - Country:US
Mailing Address - Phone:651-430-3800
Mailing Address - Fax:651-430-3827
Practice Address - Street 1:7373 FRANCE AVE S STE 408
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4549
Practice Address - Country:US
Practice Address - Phone:651-430-3800
Practice Address - Fax:651-430-3827
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2024-05-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN40092207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN257S0NUOtherBCBS MN
MN684016700Medicaid