Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 044014 | MI |
NPI | 1053308395 |
---|---|
Provider Name | Dr. Carl F Eiben |
First Address | Marquette, MI 49855 |
Second Address | Marquette, MI 49855 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 31/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
250E26047 | BLUE CROSS BLUE SHIELD MI (01) | MI |
2900018 | (05) | MI |
B43244 | (02) | MI |