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NPI Code Detail

MEDICARE: DR. ANDREW MARK EISEN MD

MEDICARE: DR. ANDREW MARK EISEN 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
1208000000XPediatrics Physician8263NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CS08874OTHERNVSTATE PHARMACY

General Provider Information

NPI Number : 1275511099
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREW MARK EISEN MD
Provider Business Mailing Address
First Line : 874 AMERICAN PACIFIC DR
Second Line :
City : HENDERSON
State : NV
Zip : 89014-8800
Country : US
Telephone Number : 702-777-8687
Fax Number : 702-777-4830
Provider Business Practice Location Address
First Line : 874 AMERICAN PACIFIC DR
Second Line :
City : HENDERSON
State : NV
Zip : 89014-8800
Country : US
Telephone Number : 702-777-8687
Fax Number : 702-777-4830
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/03/2006
Last Update Date : 03/07/2023

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