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NPI Code Detail

MEDICARE: ARIC JAY ECKHARDT, M.D., S.C.

MEDICARE: ARIC JAY ECKHARDT, M.D., S.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208200000XPlastic Surgery Physician036099360IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053585513
Entity Type Code : Organization
Provider Name (Legal Business Name) : ARIC JAY ECKHARDT, M.D., S.C.
Provider Business Mailing Address
First Line : 3900 28TH AVENUE DR
Second Line : SUITE 105
City : MOLINE
State : IL
Zip : 61265-5536
Country : US
Telephone Number : 309-764-4650
Fax Number : 866-633-1827
Provider Business Practice Location Address
First Line : 3900 28TH AVENUE DR
Second Line : SUITE 105
City : MOLINE
State : IL
Zip : 61265-5536
Country : US
Telephone Number : 309-764-4650
Fax Number : 866-633-1827
Authorized Official
Title or Position : PRESIDENT/OWNER
Name : DR. ARIC JAY ECKHARDT
Credential : M.D., F.A.C.S.
Telephone Number : 309-764-4650
Provider Enumeration Date : 04/16/2008
Last Update Date : 11/25/2013

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