Provider Demographics
NPI:1356400378
Name:EICKHOLT, JOHN L (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:EICKHOLT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 MACKENZIE DR FL 2
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2967
Mailing Address - Country:US
Mailing Address - Phone:614-273-2250
Mailing Address - Fax:614-273-2255
Practice Address - Street 1:974 BETHEL RD STE E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2467
Practice Address - Country:US
Practice Address - Phone:614-273-2230
Practice Address - Fax:614-538-2418
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042332174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist