Provider Demographics
NPI:1861518979
Name:RITA P ECKENRODE MD
Entity type:Organization
Organization Name:RITA P ECKENRODE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RITA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ECKENRODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-973-7203
Mailing Address - Street 1:2301 S HURON PKWY
Mailing Address - Street 2:STE 3C
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5133
Mailing Address - Country:US
Mailing Address - Phone:734-973-7203
Mailing Address - Fax:734-973-7204
Practice Address - Street 1:2301 S HURON PKWY
Practice Address - Street 2:STE 3C
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104
Practice Address - Country:US
Practice Address - Phone:734-973-7204
Practice Address - Fax:734-973-7204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2941057Medicaid
MI1608142061OtherBCBS
MI2393503004OtherCIGNA
MIC5442OtherMCARE
MIC5442OtherMCARE
MI1608142061OtherBCBS