Provider Demographics
NPI:1629006218
Name:ECKFELDT, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:ECKFELDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:420 DELAWARE STREET SE
Mailing Address - Street 2:MMC 609 UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-0622
Mailing Address - Fax:612-626-2696
Practice Address - Street 1:420 DELAWARE STREET SE, 760 MAYO MEMORIAL BUILDING
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-0622
Practice Address - Fax:612-626-2696
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN23510207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN11-74539OtherMEDICA PRIMARY
SD7777470Medicaid
WI32622700Medicaid
IA0507590Medicaid
MN276705800Medicaid
MN101354OtherUCARE
MT51170Medicaid
MN1009092OtherPREFERRED ONE
ND10387Medicaid
MN768093OtherARAZ
MN2T213ECOtherBCBS
MN11-22544OtherMEDICA CHOICE
MNHP22283OtherHEALTHPARTNERS
ND10387Medicaid
IA0507590Medicaid