Provider Demographics
NPI:1518939578
Name:EICHMANN, MILTON R (MD)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:R
Last Name:EICHMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 LUCY LEE PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2436
Mailing Address - Country:US
Mailing Address - Phone:573-686-7575
Mailing Address - Fax:573-686-5199
Practice Address - Street 1:2530 LUCY LEE PKWY STE 1
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2436
Practice Address - Country:US
Practice Address - Phone:573-686-7575
Practice Address - Fax:573-686-5199
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003026717208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208975706Medicaid
MO916074152Medicare ID - Type Unspecified
MO208975706Medicaid