Provider Demographics
NPI:1083860597
Name:EISNER, ARLYNNE MILDRED (MD)
Entity Type:Individual
Prefix:DR
First Name:ARLYNNE
Middle Name:MILDRED
Last Name:EISNER
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 1:955 S BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-9701
Mailing Address - Country:US
Mailing Address - Phone:269-637-5271
Mailing Address - Fax:
Practice Address - Street 1:955 S BAILEY AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-9701
Practice Address - Country:US
Practice Address - Phone:269-427-5811
Practice Address - Fax:269-427-6107
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301096175207Q00000X
OH57.013769390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP00895605OtherRAILROAD MEDICARE
MIP00895605OtherRAILROAD MEDICARE