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NPI Code Detail

MEDICARE: DR. KENNETH LAWRENCE EISENBERG M.D.

MEDICARE: DR. KENNETH LAWRENCE EISENBERG M.D.
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
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianG1381TX
22086S0129XVascular Surgery PhysicianG1381TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659376929
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH LAWRENCE EISENBERG M.D.
Provider Business Mailing Address
First Line : 1600 MEDICAL CENTER DR
Second Line : STE 212
City : EL PASO
State : TX
Zip : 79902-5008
Country : US
Telephone Number : 915-532-3977
Fax Number : 915-532-5866
Provider Business Practice Location Address
First Line : 1600 MEDICAL CENTER DR
Second Line : STE 212
City : EL PASO
State : TX
Zip : 79902-5008
Country : US
Telephone Number : 915-532-3977
Fax Number : 915-532-5866
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2005
Last Update Date : 01/31/2011

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Directions to “ DR. KENNETH LAWRENCE EISENBERG M.D.” Practice Location

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