Provider Demographics
NPI:1710417308
Name:EICKHOFF, EVLYN ISABEL (MD)
Entity type:Individual
Prefix:
First Name:EVLYN
Middle Name:ISABEL
Last Name:EICKHOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12515 ORANGE DR STE 804
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-4309
Mailing Address - Country:US
Mailing Address - Phone:239-428-7210
Mailing Address - Fax:844-670-3932
Practice Address - Street 1:12515 ORANGE DR STE 804
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4309
Practice Address - Country:US
Practice Address - Phone:239-428-7210
Practice Address - Fax:844-670-3932
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI71959208M00000X
NM390200000X
FLME163706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program