Provider Demographics
NPI:1487139929
Name:ECKERT, RALEIGH D (PA, MSPH)
Entity type:Individual
Prefix:
First Name:RALEIGH
Middle Name:D
Last Name:ECKERT
Suffix:
Gender:F
Credentials:PA, MSPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 MCMILLAN RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-3457
Mailing Address - Country:US
Mailing Address - Phone:313-408-4214
Mailing Address - Fax:
Practice Address - Street 1:18700 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE FARMS
Practice Address - State:MI
Practice Address - Zip Code:48236-2923
Practice Address - Country:US
Practice Address - Phone:313-925-3486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010051363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant