Healthcare Provider Details

I. General information

NPI: 1649237678
Provider Name (Legal Business Name): ANITA W EISENHART DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DISTRICT MEDICAL GROUP 2929 E. THOMAS RD
PHOENIX AZ
85016
US

IV. Provider business mailing address

2929 E THOMAS RD
PHOENIX AZ
85016-8034
US

V. Phone/Fax

Practice location:
  • Phone: 602-470-5000
  • Fax:
Mailing address:
  • Phone: 602-470-5000
  • Fax: 602-470-5063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number209126
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4630
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: