Individual
EVELYN ECCLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
122 W MAIN ST, BOX 570, MANCHESTER, MI 48158-1002
(734) 428-8381
(734) 428-9066
Mailing address
122 W MAIN ST, BOX 570, MANCHESTER, MI 48158-1002
(734) 428-8381
(734) 428-9066
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301043902
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0811119
BLUE CROSS/BLUE SHIELD
MI
05
—
1802237
—
MI
Enumeration date
09/28/2006
Last updated
07/28/2008
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