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NPI Code Detail

MEDICARE: LORENE S ECKBERG MD

MEDICARE: LORENE S ECKBERG MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician036-075286IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00926OTHERINDIVIDUAL MEDICARE #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831122043
Entity Type Code : Individual
Provider Name (Legal Business Name) : LORENE S ECKBERG MD
Provider Business Mailing Address
First Line : 2357 SEQUOIA DR
Second Line :
City : AURORA
State : IL
Zip : 60506-6222
Country : US
Telephone Number : 630-859-6800
Fax Number :
Provider Business Practice Location Address
First Line : 4100 HEALTHWAY DR
Second Line :
City : AURORA
State : IL
Zip : 60504-4163
Country : US
Telephone Number : 630-851-3105
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2006
Last Update Date : 02/17/2017

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