Provider Demographics
NPI:1619038171
Name:ECKSTEIN, WILLIAM LAURENCE (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LAURENCE
Last Name:ECKSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 N TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-3988
Mailing Address - Country:US
Mailing Address - Phone:765-288-1928
Mailing Address - Fax:765-741-0310
Practice Address - Street 1:205 N TILLOTSON AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-3900
Practice Address - Country:US
Practice Address - Phone:765-291-5437
Practice Address - Fax:765-751-9114
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036066126208000000X
IN0109455A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1467456996OtherCLINIC NPI NUMBER
IL371339856001Medicaid
IL1467456996OtherCLINIC NPI NUMBER