Healthcare Provider Details

I. General information

NPI: 1295700904
Provider Name (Legal Business Name): MICHELLE ECKERT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 W 40TH AVE SUITE 403
PINE BLUFF AR
71603-6319
US

IV. Provider business mailing address

1609 W 40TH AVE SUITE 403
PINE BLUFF AR
71603-6319
US

V. Phone/Fax

Practice location:
  • Phone: 870-534-4188
  • Fax: 870-534-7964
Mailing address:
  • Phone: 870-534-4188
  • Fax: 870-534-7964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE2626
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: