Organization
EVELYN ECCLES, MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVELYN ECCLES MD (OWNER)
(734) 428-8381
Entity
Organization
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
—
1366533689
ECCLES PERSONAL NPI
MI
01
—
1568521458
TAMAGNE PERSONAL NPI
MI
05
—
1802237
—
MI
Enumeration date
06/09/2007
Last updated
02/22/2008
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