Provider Demographics
NPI:1164683025
Name:ECKHOUSE, SHAINA ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAINA
Middle Name:ROSE
Last Name:ECKHOUSE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:MSC 8109-0037-09
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-454-7224
Mailing Address - Fax:877-991-4780
Practice Address - Street 1:1044 N MASON RD
Practice Address - Street 2:DIV SURG MIS, STE 320
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6431
Practice Address - Country:US
Practice Address - Phone:314-454-8877
Practice Address - Fax:877-991-4780
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2023-02-08
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Provider Licenses
StateLicense IDTaxonomies
MO2016014776208600000X
NC2015-00235208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILENROLLEDMedicaid
MO200034137Medicaid