Provider Demographics
NPI:1962670950
Name:STEPHEN G, EICHELSDORFER DPM, PA
Entity Type:Organization
Organization Name:STEPHEN G, EICHELSDORFER DPM, PA
Other - Org Name:TOWN CENTER FOOT & ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:EICHELSDORFER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:281-361-7400
Mailing Address - Street 1:8 N MAIN ST STE P
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3750
Mailing Address - Country:US
Mailing Address - Phone:281-361-7400
Mailing Address - Fax:281-361-7411
Practice Address - Street 1:8 N MAIN ST STE P
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3750
Practice Address - Country:US
Practice Address - Phone:281-361-7400
Practice Address - Fax:877-242-8502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4568100003Medicare NSC