Provider Demographics
NPI:1124194105
Name:EISELE, KARLA S (MD)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:S
Last Name:EISELE
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 1:300 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:OROFINO
Mailing Address - State:ID
Mailing Address - Zip Code:83544-9034
Mailing Address - Country:US
Mailing Address - Phone:208-476-4511
Mailing Address - Fax:208-476-7898
Practice Address - Street 1:300 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:OROFINO
Practice Address - State:ID
Practice Address - Zip Code:83544-9034
Practice Address - Country:US
Practice Address - Phone:208-476-4511
Practice Address - Fax:208-476-7898
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM96562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry