Provider Demographics
NPI:1457410375
Name:MARKOVITZ, ERICA LYN (MD)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:LYN
Last Name:MARKOVITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 639295
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9295
Mailing Address - Country:US
Mailing Address - Phone:248-824-6000
Mailing Address - Fax:855-618-6655
Practice Address - Street 1:1194 OAK VALLEY DR STE 80B
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-8942
Practice Address - Country:US
Practice Address - Phone:734-975-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080006208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM82237069Medicaid
AZ255534Medicaid
MI4931935Medicaid
CO16501845Medicaid
MI4301080006OtherSTATE LICENSE
AZ255534Medicaid
NM82237069Medicaid
320059Medicare Oscar/Certification