Provider Demographics
NPI:1588642532
Name:EICHELSDORFER, STEPHEN G (DPM)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:EICHELSDORFER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N MAIN ST STE P
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3750
Mailing Address - Country:US
Mailing Address - Phone:281-361-7400
Mailing Address - Fax:877-242-8502
Practice Address - Street 1:8 N MAIN ST
Practice Address - Street 2:STE P
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3748
Practice Address - Country:US
Practice Address - Phone:281-361-7400
Practice Address - Fax:877-242-8502
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1175213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU42217Medicare UPIN
TX4568100003Medicare NSC
TX8B2501Medicare PIN
TX4568100002Medicare NSC
TX4568100001Medicare NSC
TX8B2503Medicare PIN