Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0203X | Pediatric Critical Care Doctor | 31493 | AZ |
Y | 2080P0203X | Pediatric Critical Care Doctor | 42311 | MN |
NPI | 1265405120 |
---|---|
Provider Name | Dr. Mark H Eikenberry |
First Address | Minneapolis, MN 55404-4387 |
Second Address | Minneapolis, MN 55404-4387 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 28/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
798621 | (05) | AZ |
H52992 | (02) |