Provider Demographics
NPI:1619997160
Name:ECKHOLM, DANN MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:DANN
Middle Name:MICHELLE
Last Name:ECKHOLM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANN
Other - Middle Name:
Other - Last Name:SACCONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2012 MONROE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2938
Mailing Address - Country:US
Mailing Address - Phone:313-274-8346
Mailing Address - Fax:
Practice Address - Street 1:6071 W OUTER DR
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2624
Practice Address - Country:US
Practice Address - Phone:313-966-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301076392207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H88555Medicare UPIN