Provider Demographics
NPI:1649536186
Name:EICHINGER, MICHELLE W (DO)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:W
Last Name:EICHINGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:A
Other - Last Name:WYSZOMIRSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1701 W. SUPERIOR
Mailing Address - Street 2:ERIE FAMILY HEALTH CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622
Mailing Address - Country:US
Mailing Address - Phone:312-666-3494
Mailing Address - Fax:312-432-4354
Practice Address - Street 1:5215 N. CALIFORNIA AVENUE
Practice Address - Street 2:ERIE FAMILY FOSTER AVENUE HEALTH CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625
Practice Address - Country:US
Practice Address - Phone:312-666-3494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036140346207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-140346Medicaid