Provider Demographics
NPI:1306099387
Name:EICHENBAUM, ANNETTE (DO)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:EICHENBAUM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:CHMIELEWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 100267
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0267
Mailing Address - Country:US
Mailing Address - Phone:727-327-2600
Mailing Address - Fax:727-327-2644
Practice Address - Street 1:4400 140TH AVE N
Practice Address - Street 2:SUITE 110
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3832
Practice Address - Country:US
Practice Address - Phone:727-327-2600
Practice Address - Fax:727-327-2644
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 10507208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001619000Medicaid
FLCP271ZMedicare PIN