Provider Demographics
NPI:1669509998
Name:EICHLER, JAY (DPM)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:EICHLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 DEXTER ST
Mailing Address - Street 2:STE 100
Mailing Address - City:MILAN
Mailing Address - State:MI
Mailing Address - Zip Code:48160-1160
Mailing Address - Country:US
Mailing Address - Phone:734-439-3350
Mailing Address - Fax:734-439-3357
Practice Address - Street 1:909 DEXTER ST
Practice Address - Street 2:STE 100
Practice Address - City:MILAN
Practice Address - State:MI
Practice Address - Zip Code:48160-1160
Practice Address - Country:US
Practice Address - Phone:734-439-3350
Practice Address - Fax:734-439-3357
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001486213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2745897Medicaid
MIMI2851001Medicare PIN
U17466Medicare UPIN