Provider Demographics
NPI:1821289141
Name:EICHENSEER, PETER JOSPEH (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOSPEH
Last Name:EICHENSEER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:W129N7055 NORTHFIELD DR
Mailing Address - Street 2:BUILDING A, SUITE 303
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-0538
Mailing Address - Country:US
Mailing Address - Phone:262-253-5400
Mailing Address - Fax:262-253-3339
Practice Address - Street 1:W129N7055 NORTHFIELD DR
Practice Address - Street 2:BUILDING A, SUITE 303
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-0538
Practice Address - Country:US
Practice Address - Phone:262-253-5400
Practice Address - Fax:262-253-3339
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.052595207R00000X
WI61054207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1821289141Medicaid