Provider Demographics
NPI:1174528921
Name:EISENBERG, ANDREW C (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5301 E HURON RIVER DR
Mailing Address - Street 2:STE C139
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1051
Mailing Address - Country:US
Mailing Address - Phone:734-712-1000
Mailing Address - Fax:734-712-3218
Practice Address - Street 1:5301 E HURON RIVER DR
Practice Address - Street 2:STE C139
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1051
Practice Address - Country:US
Practice Address - Phone:734-712-1000
Practice Address - Fax:734-712-3218
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI033957207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1580602Medicaid
MI0H16099002Medicare ID - Type Unspecified
MIB48432Medicare UPIN