Provider Demographics
NPI:1588691968
Name:EISENHOWER, MICHELLE M (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:M
Last Name:EISENHOWER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 WILLIAM EBBS LN
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5210
Mailing Address - Country:US
Mailing Address - Phone:610-470-3222
Mailing Address - Fax:610-431-7040
Practice Address - Street 1:500 WILLIAM EBBS LN
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5210
Practice Address - Country:US
Practice Address - Phone:610-470-3222
Practice Address - Fax:877-996-4485
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH83063Medicare UPIN
PA119991Medicare PIN