Healthcare Provider Details

I. General information

NPI: 1831120930
Provider Name (Legal Business Name): JAMES NOAH EICKHOLZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 NEW HOLT RD
PADUCAH KY
42001-7455
US

IV. Provider business mailing address

2425 NEW HOLT RD
PADUCAH KY
42001-7455
US

V. Phone/Fax

Practice location:
  • Phone: 270-441-4850
  • Fax: 270-441-4666
Mailing address:
  • Phone: 270-441-4850
  • Fax: 270-441-4666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32988
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: