Healthcare Provider Details

I. General information

NPI: 1700863925
Provider Name (Legal Business Name): MATTHEW M EISENSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 E ROLLINS RD 5 METTAWA LANE
RIVERWOODS IL
60015-3551
US

IV. Provider business mailing address

5 METTAWA LANE SUITE N500
RIVERWOODS IL
60015-3551
US

V. Phone/Fax

Practice location:
  • Phone: 847-546-3600
  • Fax: 847-546-3633
Mailing address:
  • Phone: 414-455-4780
  • Fax: 414-475-2936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036072680
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: