Provider Demographics
NPI:1285413856
Name:EICHENAUER MD LLC
Entity type:Organization
Organization Name:EICHENAUER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EICHENAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-358-1967
Mailing Address - Street 1:209 E 68TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64113-2436
Mailing Address - Country:US
Mailing Address - Phone:816-514-6998
Mailing Address - Fax:602-584-6860
Practice Address - Street 1:209 E 68TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64113-2436
Practice Address - Country:US
Practice Address - Phone:816-514-6998
Practice Address - Fax:602-584-6860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty