Healthcare Provider Details

I. General information

NPI: 1255339412
Provider Name (Legal Business Name): SANDRA ADAMS EISELE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11140 MONTGOMERY RD
CINCINNATI OH
45249-2309
US

IV. Provider business mailing address

11140 MONTGOMERY RD
CINCINNATI OH
45249-2309
US

V. Phone/Fax

Practice location:
  • Phone: 513-271-3222
  • Fax: 513-271-3135
Mailing address:
  • Phone: 513-271-3222
  • Fax: 513-271-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35050325
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: