Provider Demographics
NPI:1396812798
Name:EISENBERG, LEOPOLDO (MD)
Entity type:Individual
Prefix:
First Name:LEOPOLDO
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 1:28455 HAGGERTY RD
Mailing Address - Street 2:SUITE #203
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-2982
Mailing Address - Country:US
Mailing Address - Phone:248-324-4444
Mailing Address - Fax:248-324-2444
Practice Address - Street 1:28455 HAGGERTY RD
Practice Address - Street 2:SUITE #203
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-2982
Practice Address - Country:US
Practice Address - Phone:248-324-4444
Practice Address - Fax:248-324-2444
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033530207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4638911Medicaid
MIB46191Medicare UPIN
N96910001Medicare PIN