Healthcare Provider Details

I. General information

NPI: 1255518486
Provider Name (Legal Business Name): EHRENTRAUD JOHANNA EICHELBAUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21685 KINGSLAND BLVD
KATY TX
77450-2512
US

IV. Provider business mailing address

8514 SUN CORAL DR
CYPRESS TX
77433-7529
US

V. Phone/Fax

Practice location:
  • Phone: 346-594-2104
  • Fax: 346-594-2103
Mailing address:
  • Phone: 941-779-4869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberU7674
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number18573
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberU7674
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME140028
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: