Healthcare Provider Details

I. General information

NPI: 1598757031
Provider Name (Legal Business Name): DAVID JEFFREY EISENSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MEMORIAL DR DEPT PATHOLOGY
BELLEVILLE IL
62226-5360
US

IV. Provider business mailing address

660 S EUCLID AVE CB 8118
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-7750
  • Fax: 314-747-1710
Mailing address:
  • Phone: 314-362-5641
  • Fax: 314-362-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number036136527
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036136527
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: