Provider Demographics
NPI:1659600336
Name:MICHAEL L. EISEMANN, M.D.,P.A.,F.A.C.S.
Entity Type:Organization
Organization Name:MICHAEL L. EISEMANN, M.D.,P.A.,F.A.C.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:EISEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-790-1771
Mailing Address - Street 1:6550 FANNIN ST
Mailing Address - Street 2:STE 2119
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-790-1771
Mailing Address - Fax:713-790-0575
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:STE 2119
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-790-1771
Practice Address - Fax:713-790-0575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9185174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1518106459Medicare PIN
TX1821095639Medicare PIN