Healthcare Provider Details

I. General information

NPI: 1417432261
Provider Name (Legal Business Name): AVRAHAM EISENSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 01/23/2024
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7447 W TALCOTT AVE STE 182
CHICAGO IL
60631-3712
US

IV. Provider business mailing address

7447 W TALCOTT AVE STE 182
CHICAGO IL
60631-3712
US

V. Phone/Fax

Practice location:
  • Phone: 773-792-5155
  • Fax:
Mailing address:
  • Phone: 773-792-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.081276
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: