Healthcare Provider Details

I. General information

NPI: 1134101264
Provider Name (Legal Business Name): TIM E ECKSTEIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2919 WILDER RD SUITE 130
BAY CITY MI
48706-9299
US

IV. Provider business mailing address

1447 N HARRISON ST
SAGINAW MI
48602-4727
US

V. Phone/Fax

Practice location:
  • Phone: 989-671-5720
  • Fax: 989-671-5728
Mailing address:
  • Phone: 989-671-5720
  • Fax: 989-671-5728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101011920
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number5101011920
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: