Provider Demographics
NPI:1255339412
Name:EISELE, SANDRA ADAMS (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:ADAMS
Last Name:EISELE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-2309
Mailing Address - Country:US
Mailing Address - Phone:513-271-3222
Mailing Address - Fax:513-271-3135
Practice Address - Street 1:11140 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249-2309
Practice Address - Country:US
Practice Address - Phone:513-271-3222
Practice Address - Fax:513-271-3135
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050325207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0877618OtherMEDICAID
OH704440OtherBUCKEYE MEDICARE
OHP01241849OtherRAILROAD
OH768864OtherANTHEM
OH744311OtherBUCKEYE MEDICAID
OHH101060OtherMEDICARE
OH4230729OtherAETNA
OH273088817059OtherCARESOURCE
OH744311OtherBUCKEYE MEDICAID
OH273088817059OtherCARESOURCE
OH4230729OtherAETNA