Provider Demographics
NPI:1821095639
Name:EISEMANN, MICHAEL LOUIS (MD PA FACS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LOUIS
Last Name:EISEMANN
Suffix:
Gender:M
Credentials:MD PA FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2013-05-30
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-06
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00RK22Medicare ID - Type Unspecified
TXB22486Medicare UPIN