Provider Demographics
NPI:1366488587
Name:SALMAN, ERIC SAGE (PAC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:SAGE
Last Name:SALMAN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1950 NORTHWESTERN AVE S
Mailing Address - Street 2:STE 102
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:651-241-7272
Practice Address - Street 1:1835 COUNTY ROAD C W STE 150
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1343
Practice Address - Country:US
Practice Address - Phone:651-430-3800
Practice Address - Fax:651-430-3827
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI00062701363A00000X
MN00062924363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN970000766OtherRR MEDICARE
MN1022092OtherAMERICAS PPO
WI42994400Medicaid
MNHP30663OtherHEALTHPARTNERS
MN801634800Medicaid
MN129779OtherUCARE
MN56B10SAOtherBLUE CROSS & BLUE SHIELD
MN0119751OtherMEDICA
MN1023774OtherPREFERRED ONE
MN56B10SAOtherBLUE CROSS & BLUE SHIELD
MN0119751OtherMEDICA
MN1023774OtherPREFERRED ONE
MN801634800Medicaid