Provider Demographics
NPI:1962677872
Name:ECKHART, MICHELLE SCHUPPE (RD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SCHUPPE
Last Name:ECKHART
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-361-6025
Mailing Address - Fax:502-363-7935
Practice Address - Street 1:100 E LIBERTY ST
Practice Address - Street 2:SUITE 210
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1434
Practice Address - Country:US
Practice Address - Phone:502-361-6025
Practice Address - Fax:502-363-7935
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1490133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00546069Medicare Oscar/Certification