Healthcare Provider Details

I. General information

NPI: 1376587493
Provider Name (Legal Business Name): WILLIAM GERHARDT EISCHEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 DES MOINES ST SUITE: 110
DES MOINES IA
50309
US

IV. Provider business mailing address

PO BOX 1475
DES MOINES IA
50305-1475
US

V. Phone/Fax

Practice location:
  • Phone: 515-643-0833
  • Fax: 515-643-0933
Mailing address:
  • Phone: 515-643-0833
  • Fax: 515-643-0933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02094
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: