Provider Demographics
NPI:1053322263
Name:ECKSTAT, STEPHEN (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:ECKSTAT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6347 NE 46TH ST
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-9488
Mailing Address - Country:US
Mailing Address - Phone:515-222-7000
Mailing Address - Fax:515-222-2737
Practice Address - Street 1:1601 NW 114TH ST
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-7007
Practice Address - Country:US
Practice Address - Phone:515-222-7000
Practice Address - Fax:515-222-7037
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01478207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1089672Medicaid
IAA00993Medicare UPIN
IA1089672Medicaid