Provider Demographics
NPI:1689653214
Name:EIS, MICHAEL (PHD, MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:EIS
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E WASHINGTON STREET
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-2003
Mailing Address - Country:US
Mailing Address - Phone:262-335-4583
Mailing Address - Fax:262-335-6827
Practice Address - Street 1:N91W17271 APPLETON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-2045
Practice Address - Country:US
Practice Address - Phone:262-502-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI433722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34115600Medicaid
WIH21671Medicare UPIN
WI84145Medicare PIN
WI34115600Medicaid
WI68375Medicare PIN