Provider Demographics
NPI:1770529844
Name:EISCHENS, SHELBY (MD)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:
Last Name:EISCHENS
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 1:400 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-2497
Mailing Address - Country:US
Mailing Address - Phone:605-697-9500
Mailing Address - Fax:605-697-6939
Practice Address - Street 1:400 22ND AVE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2497
Practice Address - Country:US
Practice Address - Phone:605-697-9500
Practice Address - Fax:605-697-6939
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN47323207Q00000X
SD7820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0121770OtherMEDICA #
MNHP55906OtherHEALTHPARTNERS #
MN008H6EIOtherMNBS #
MN26009OtherNDBS #
MN008H4EIOtherMNBS #
MN137007OtherUCARE #
MN09829MEOtherMNBS #
MN45610OtherLHS/BANNERHEALTH #
MNDA9041044891OtherPREFERRED ONE #
MN0123434OtherMEDICA #
MN2052390OtherAMERICA'S PPO/ARAZ #
MN382170600Medicaid
MN0123435OtherMEDICA #
MN930002502Medicare PIN
MN26009OtherNDBS #
MN2052390OtherAMERICA'S PPO/ARAZ #
MN137007OtherUCARE #
MNI27408Medicare UPIN