Provider Demographics
NPI:1598757031
Name:EISENSTEIN, DAVID JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JEFFREY
Last Name:EISENSTEIN
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8118
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-5641
Mailing Address - Fax:314-362-0369
Practice Address - Street 1:4500 MEMORIAL DR
Practice Address - Street 2:DEPT PATHOLOGY
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5360
Practice Address - Country:US
Practice Address - Phone:618-233-7750
Practice Address - Fax:314-747-1710
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036136527207ZP0101X
KY30258207ZP0101X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200016959Medicaid
OH2460564Medicaid
KY64076409Medicaid
OH2460564Medicaid
KY0655092Medicare PIN
IN200938560Medicaid
KY220021974Medicare PIN
KY64076409Medicaid