Healthcare Provider Details

I. General information

NPI: 1811172612
Provider Name (Legal Business Name): STEPHANIE CAROLINE EISENBARTH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE CAROLINE EISENBARTH M.D.

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST STE 7-325
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

251 E HURON ST STE 7-325
CHICAGO IL
60611-2908
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-7405
  • Fax: 312-926-3127
Mailing address:
  • Phone: 312-926-7405
  • Fax: 312-926-3127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number046721
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number036159286
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: