Provider Demographics
NPI:1104026350
Name:MICHELLE EISENHOWER M.D.
Entity Type:Organization
Organization Name:MICHELLE EISENHOWER M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-783-5158
Mailing Address - Street 1:MICHELLE EISENHOWER M.D.
Mailing Address - Street 2:500 WILLIAM EBBS LA.
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380
Mailing Address - Country:US
Mailing Address - Phone:215-952-9515
Mailing Address - Fax:215-952-1431
Practice Address - Street 1:MICHELLE EISENHOWER M.D.
Practice Address - Street 2:2301 S. BROAD ST., M.O.B. SUITE 201
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148
Practice Address - Country:US
Practice Address - Phone:215-952-9515
Practice Address - Fax:215-952-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421472207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA069423Medicare PIN
PAH83063Medicare UPIN