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1407820590

NPI Code Detail

MEDICARE: BERNARD HENRY EISENGA M.D.

MEDICARE: BERNARD HENRY EISENGA M.D.

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	4301067263	MI
2	207L00000X	Anesthesiology Physician	4301067263	MI
3	207R00000X	Internal Medicine Physician	4301067263	MI
4	208M00000X	Hospitalist Physician	4301067263	MI
5	207PT0002X	Medical Toxicology (Emergency Medicine) Physician	4301067263	MI

General Provider Information

NPI Number	:	1407820590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNARD HENRY EISENGA M.D.

Provider Business Mailing Address
First Line	:	4100 EMBASSY DR SE STE 400
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2416
Country	:	US
Telephone Number	:	616-975-1845
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 MICHIGAN ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2531
Country	:	US
Telephone Number	:	616-391-3777
Fax Number	:	616-391-3755

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	01/13/2025

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Directions to “ BERNARD HENRY EISENGA M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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