Basic Information
| Provider Information | |||||||||
| NPI: | 1548298466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ECKLES | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1523 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727021523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4795716038 | ||||||||
| FaxNumber: | 4795820222 | ||||||||
| Practice Location | |||||||||
| Address1: | 3344 N FUTRALL DR | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4795218200 | ||||||||
| FaxNumber: | 4795827310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 12/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0012X | E-2694 | AR | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RC0200X | E-2694 | AR | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | E-2694 | AR | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | P00272713 | 01 | AR | RR MCR | OTHER | 158828001 | 05 | AR | MEDICAID | 200070290A | 05 | OK | MEDICAID | 5N380 | 01 | AR | AR BC/BS | OTHER |