Provider Demographics
NPI:1336451897
Name:EICHENBERG, ALICIA CHRISTINE (MD)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:CHRISTINE
Last Name:EICHENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ALICIA
Other - Middle Name:CHRISTINE
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 MICHIGAN ST NE # MC845
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2750 E BELTLINE AVE NE FL 1
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-447-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-12
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096366207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301096366OtherMICHIGAN EDUCATION LIMITED LICENSE NUMBER