Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 36-00-2916 | OH |
NPI | 1306833769 |
---|---|
Provider Name | Dr. Michael Joseph Eisenman |
First Address | Apo, AE 09464-0051 |
Second Address | Apo, AE 09461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 15/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0284571 | (05) | OH |
U062792 | (02) | OH |