Provider Demographics
NPI:1144221698
Name:EISER, RICHARD D (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:EISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5775 WAYZATA BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1222
Mailing Address - Country:US
Mailing Address - Phone:320-762-6040
Mailing Address - Fax:320-762-6038
Practice Address - Street 1:111 17TH AVE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-3703
Practice Address - Country:US
Practice Address - Phone:320-762-6040
Practice Address - Fax:320-762-6038
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN212902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN111010C561OtherUCARE OF MINNESOTA
MN16-06657OtherMEDICA
MN300049999OtherRAILROAD MEDICARE
MN328598700Medicaid
MN595986OtherARAZ/ AMERICA'S PPO
MN60158EIOtherBLUE CROSS BLUE SHIELD
MN965251000597OtherPREFERRED ONE
MNHP38535OtherHEALTH PARTNERS
MN411772562OtherGREATWEST HEALTHCARE
MN411772562OtherTRICARE
MN595986OtherARAZ/ AMERICA'S PPO
D48530Medicare UPIN