MEDICARE: HOWARD EISENBERG MD FCCP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	ME66815	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DF2856	OTHER		RAILROAD MEDICARE

General Provider Information

NPI Number	:	1134296361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOWARD EISENBERG MD FCCP LLC

Provider Business Mailing Address
First Line	:	1031 SE 9TH PLACE
Second Line	:	UNIT 2
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3003
Country	:	US
Telephone Number	:	239-573-8448
Fax Number	:	239-573-8604

Provider Business Practice Location Address
First Line	:	1031 SE 9TH PLACE
Second Line	:	UNIT 2
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3003
Country	:	US
Telephone Number	:	239-573-8448
Fax Number	:	239-573-8604

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HOWARD EISENBERG
Credential	:	MD
Telephone Number	:	239-573-8448

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	02/24/2010

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