Healthcare Provider Details

I. General information

NPI: 1619038171
Provider Name (Legal Business Name): WILLIAM LAURENCE ECKSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/30/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N TILLOTSON AVE
MUNCIE IN
47304-3900
US

IV. Provider business mailing address

240 N TILLOTSON AVE
MUNCIE IN
47304-3988
US

V. Phone/Fax

Practice location:
  • Phone: 765-291-5437
  • Fax: 765-751-9114
Mailing address:
  • Phone: 765-288-1928
  • Fax: 765-741-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036066126
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0109455A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: