Healthcare Provider Details

I. General information

NPI: 1285543942
Provider Name (Legal Business Name): MADISON ANNE EISENBRAUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 ELBRIDGE PAYNE RD
CHESTERFIELD MO
63017-8538
US

IV. Provider business mailing address

3300 FEE FEE RD
BRIDGETON MO
63044-3225
US

V. Phone/Fax

Practice location:
  • Phone: 636-898-2060
  • Fax:
Mailing address:
  • Phone: 314-556-8129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: