Provider Demographics
NPI:1730156647
Name:ECKHARDT, ARIC J (MD)
Entity type:Individual
Prefix:DR
First Name:ARIC
Middle Name:J
Last Name:ECKHARDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3900 28TH AVE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-5536
Mailing Address - Country:US
Mailing Address - Phone:309-764-4650
Mailing Address - Fax:866-633-1827
Practice Address - Street 1:3900 28TH AVE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-5536
Practice Address - Country:US
Practice Address - Phone:309-764-4650
Practice Address - Fax:866-633-1827
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036099360208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36099360Medicaid
IA513138Medicaid
IAI3220Medicare ID - Type Unspecified
G88693Medicare UPIN
IL36099360Medicaid