Provider Demographics
NPI:1649164864
Name:EVLYN EICKHOFF, M.D., PLLC.
Entity type:Organization
Organization Name:EVLYN EICKHOFF, M.D., PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:EICKHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-392-1500
Mailing Address - Street 1:11300 NW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2023
Mailing Address - Country:US
Mailing Address - Phone:505-392-1500
Mailing Address - Fax:
Practice Address - Street 1:12515 ORANGE DR STE 804
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-4309
Practice Address - Country:US
Practice Address - Phone:505-392-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty