Provider Demographics
NPI:1700863925
Name:EISENSTEIN, MATTHEW M (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:M
Last Name:EISENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5 METTAWA LANE
Mailing Address - Street 2:SUITE N500
Mailing Address - City:RIVERWOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3551
Mailing Address - Country:US
Mailing Address - Phone:414-455-4780
Mailing Address - Fax:414-475-2936
Practice Address - Street 1:720 E ROLLINS RD
Practice Address - Street 2:5 METTAWA LANE
Practice Address - City:RIVERWOODS
Practice Address - State:IL
Practice Address - Zip Code:60015-3551
Practice Address - Country:US
Practice Address - Phone:847-546-3600
Practice Address - Fax:847-546-3633
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2011-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0360726802085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036072680Medicaid
IL036072680Medicaid
L89896Medicare PIN
IN499500LLLLMedicare PIN