Healthcare Provider Details

I. General information

NPI: 1629031034
Provider Name (Legal Business Name): THOMAS CRAIG EISENSTADT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 NICOLLET MALL SUITE 221 EISENSTADT ALLERGY & ASTHMA LLP
MINNEAPOLIS MN
55426
US

IV. Provider business mailing address

825 NICOLLET MALL SUITE 221
MINNEAPOLIS MN
55402
US

V. Phone/Fax

Practice location:
  • Phone: 612-339-0807
  • Fax: 612-339-1854
Mailing address:
  • Phone: 612-339-0807
  • Fax: 612-339-1854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25635
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: