MEDICARE: MICHAEL J. EISNER 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	207P00000X	Emergency Medicine Physician	23171	IA

General Provider Information

NPI Number	:	1255312765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J. EISNER MD

Provider Business Mailing Address
First Line	:	1202 N B ST
Second Line	:
City	:	FAIRFIELD
State	:	IA
Zip	:	52556-2084
Country	:	US
Telephone Number	:	641-472-8682
Fax Number	:

Provider Business Practice Location Address
First Line	:	1202 N B ST
Second Line	:
City	:	FAIRFIELD
State	:	IA
Zip	:	52556-2084
Country	:	US
Telephone Number	:	641-472-8682
Fax Number	:

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	07/08/2007

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