=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235150996
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EISMAN & EISMAN MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2006
-----------------------------------------------------
Last Update Date | 08/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17971 BISCAYNE BLVD STE 208
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-932-7814
-----------------------------------------------------
Fax | 305-466-9051
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17971 BISCAYNE BLVD STE 208
-----------------------------------------------------
City | AVENTURA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33160-2532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-932-7814
-----------------------------------------------------
Fax | 305-466-9051
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EUGENE HERBERT EISMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 305-932-7814
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME0015831
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | ME0015832
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------