Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 11568 | ND |
NPI | 1114106820 |
---|---|
Provider Name | Dr. John Patrick Eickman |
First Address | Grand Forks, ND 58201-4040 |
Second Address | Grand Forks, ND 58201-4040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2007 |
Last Update Date | 26/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1114106820 | (05) | MN |