Provider Demographics
NPI:1750386629
Name:EISENBERG, PAUL H (DPM)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:H
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:H
Other - Last Name:EISENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM, INC
Mailing Address - Street 1:9485 MENTOR AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8723
Mailing Address - Country:US
Mailing Address - Phone:440-205-5878
Mailing Address - Fax:440-375-8830
Practice Address - Street 1:9485 MENTOR AVE
Practice Address - Street 2:STE 200
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8723
Practice Address - Country:US
Practice Address - Phone:440-205-5878
Practice Address - Fax:440-375-8830
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH001670213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0245363Medicaid
OH480031301OtherRAILROAD MEDICARE LAKEWOO
OH480014163OtherRAILROAD MEDICARE BEREA
OH0505100003Medicare NSC
OH480014163OtherRAILROAD MEDICARE BEREA
OH0399453Medicare ID - Type UnspecifiedBRUNSWICK
OH0399451Medicare ID - Type UnspecifiedBEREA
OH0505100002Medicare NSC
OH480031301OtherRAILROAD MEDICARE LAKEWOO
OH0505100001Medicare NSC