Provider Demographics
NPI:1134101264
Name:ECKSTEIN, TIM E (DO)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:E
Last Name:ECKSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-4727
Mailing Address - Country:US
Mailing Address - Phone:989-671-5720
Mailing Address - Fax:989-671-5728
Practice Address - Street 1:2919 WILDER RD
Practice Address - Street 2:SUITE 130
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-9299
Practice Address - Country:US
Practice Address - Phone:989-671-5720
Practice Address - Fax:989-671-5728
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011920207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4589675Medicaid
MI0854102774OtherBLUE CROSS BLUE SHIELD
MI540Z90298OtherHEALTHPLUS
MI080D410020OtherBLUE CROSS BLUE SHIELD
MI1011090OtherMCLAREN HEALTH PLAN
MI080D410020OtherCOMMUNITY BLUE PPO
MI1011090OtherHEALTH ADVANTAGE NETWORK
MI5689041OtherAETNA
MI4589675Medicaid
MI080D410020OtherCOMMUNITY BLUE PPO