Evelyn Eccles, MD
Organization Active NPI Family Medicine Physician · Manchester, MI
NPI 1679776264 · NPPES record last updated Feb 22, 2008
Key facts
- NPI
- 1679776264
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 4301043902 (MI)
- Legal business name
- EVELYN ECCLES, MD
- Practice address
- 122 W Main St
Box 570
Manchester, MI 48158-1002 - Phone
- (734) 428-8381
- Fax
- (734) 428-9066
- NPI assigned
- Jun 9, 2007
- Organization subpart
- No
Authorized official
- Name
- Evelyn Eccles, MD
- Title
- Owner
- Phone
- (734) 428-8381
Practitioners 2
-
Evelyn Eccles, MD
-
Dori P Tamagne, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D0368143 | Evelyn Eccles MD | Certificate of waiver | Dec 19, 2027 |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 4301043902 | MI | Yes |
Addresses
Primary practice location
122 W Main St
Box 570
Manchester, MI 48158-1002
Mailing address
122 W Main St
Box 570
Manchester, MI 48158-1002
Phone (734) 428-8381
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568521458 | Other | MI | TAMAGNE PERSONAL NPI |
| 1366533689 | Other | MI | ECCLES PERSONAL NPI |
| 1802237 | Medicaid | MI |
Other providers in Manchester, MI
- Amber Dawn Burkhardt-Sidebottom
- Allan R Currey
- Jay Michael Demski
- Miranda Eberle
- Evelyn Eccles
- Claudia J Fall
- Brooke Fuller
- Great Lakes Bay Health Centers
- Debra Hauser
- Gary V Haynes
All providers in Manchester, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.