Provider Demographics
NPI:1811486871
Name:ALIA, ERISA (MD)
Entity type:Individual
Prefix:
First Name:ERISA
Middle Name:
Last Name:ALIA
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 1:1400 MADISON AVE STE 400A
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6805
Mailing Address - Country:US
Mailing Address - Phone:507-389-8538
Mailing Address - Fax:
Practice Address - Street 1:1400 MADISON AVE STE 400A
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6805
Practice Address - Country:US
Practice Address - Phone:507-389-8538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-05
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN78089207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology