MEDICARE: LAUREN EICHENBAUM 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	390200000X	Student in an Organized Health Care Education/Training Program
2	208100000X	Physical Medicine & Rehabilitation Physician	4301111519	MI

General Provider Information

NPI Number	:	1871892059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN EICHENBAUM MD

Provider Business Mailing Address
First Line	:	5220 HIGHLAND RD STE 210
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-1973
Country	:	US
Telephone Number	:	248-383-1030
Fax Number	:	248-383-1031

Provider Business Practice Location Address
First Line	:	5220 HIGHLAND RD STE 210
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48327-1973
Country	:	US
Telephone Number	:	248-383-1030
Fax Number	:	248-383-1031

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

Provider Enumeration Date	:	03/27/2011
Last Update Date	:	07/21/2022

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