MEDICARE: STEPHEN G. EICHELSDORFER, DPM, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist

General Provider Information

NPI Number	:	1356529713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN G. EICHELSDORFER, DPM, PA

Provider Business Mailing Address
First Line	:	8 N MAIN ST STE P
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-3750
Country	:	US
Telephone Number	:	281-361-7400
Fax Number	:	281-361-7411

Provider Business Practice Location Address
First Line	:	18700 W LAKE HOUSTON PKWY STE A105
Second Line	:
City	:	ATASCOCITA
State	:	TX
Zip	:	77346-3350
Country	:	US
Telephone Number	:	281-361-7400
Fax Number	:	877-242-8502

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	STEPHEN G. EICHELSDORFER
Credential	:	DPM
Telephone Number	:	281-361-7400

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	03/12/2024

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