MEDICARE: DR. RANDY EARL EISENHUT MD

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	208000000X	Pediatrics Physician	35058652E	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174580948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY EARL EISENHUT MD

Provider Business Mailing Address
First Line	:	PO BOX 933432
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0039
Country	:	US
Telephone Number	:	937-641-3555
Fax Number	:	937-641-4528

Provider Business Practice Location Address
First Line	:	6551 CENTERVILLE BUSINESS PKWY STE 110
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-2696
Country	:	US
Telephone Number	:	937-291-6850
Fax Number	:	947-291-6896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	03/05/2026

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