Provider Demographics
NPI:1851328488
Name:EISENSHTADT, JAMES HOWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:HOWARD
Last Name:EISENSHTADT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 W MAPLE RD
Mailing Address - Street 2:SUITE B208
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3704
Mailing Address - Country:US
Mailing Address - Phone:248-851-7181
Mailing Address - Fax:248-851-1223
Practice Address - Street 1:5600 W MAPLE RD
Practice Address - Street 2:SUITE B208
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3704
Practice Address - Country:US
Practice Address - Phone:248-851-7181
Practice Address - Fax:248-851-1223
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003797103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F34841Medicare ID - Type UnspecifiedLICENSED PSYCHOLOGIST