Provider Demographics
NPI:1922070648
Name:EISENBERG, HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
Last Name:EISENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD.
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:3680 BROADWAY
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-8005
Practice Address - Country:US
Practice Address - Phone:239-936-0380
Practice Address - Fax:239-936-6684
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66815207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17263OtherWELLCARE MEDICARE ONLY
FLP930720OtherFREEDOM HEALTH
FL249070OtherAVMED
FL25935OtherBCBS FL
FL8996323OtherCIGNA
FLP01027501OtherRAILROAD MCR
FL17263OtherWELLCARE
FL25935OtherBCBS
FLP929106OtherOPTIMUM
FL4347016OtherAETNA
FL4347016OtherAETNA
FL25935WMedicare PIN
FLB74832Medicare UPIN