Healthcare Provider Details

I. General information

NPI: 1760744478
Provider Name (Legal Business Name): JEFFREY CHARLES EICKHOFF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2012
Last Update Date: 07/09/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 S 6TH ST
BRAINERD MN
56401-4529
US

IV. Provider business mailing address

2024 S 6TH ST
BRAINERD MN
56401-4529
US

V. Phone/Fax

Practice location:
  • Phone: 218-828-7101
  • Fax: 218-828-2892
Mailing address:
  • Phone: 218-828-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number27557
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number67078
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: