Provider Demographics
NPI:1033747118
Name:EICKHOLTZ, ALLIE SANDRA (MD)
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:SANDRA
Last Name:EICKHOLTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALLIE
Other - Middle Name:SANDRA
Other - Last Name:DAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2431 S M 30 STE 216
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9388
Mailing Address - Country:US
Mailing Address - Phone:989-343-1134
Mailing Address - Fax:989-343-3621
Practice Address - Street 1:2431 S M 30 STE 216
Practice Address - Street 2:
Practice Address - City:WEST BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48661-9388
Practice Address - Country:US
Practice Address - Phone:989-343-1134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4351046434208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery