Provider Demographics
NPI:1487227385
Name:EILEEN VAN DIEST, MD, PA
Entity Type:Organization
Organization Name:EILEEN VAN DIEST, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DIEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-219-4162
Mailing Address - Street 1:179 ENTERPRISE PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-8634
Mailing Address - Country:US
Mailing Address - Phone:830-219-4162
Mailing Address - Fax:830-310-7974
Practice Address - Street 1:179 ENTERPRISE PKWY STE 102
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8634
Practice Address - Country:US
Practice Address - Phone:830-219-4162
Practice Address - Fax:830-310-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty