Provider Demographics
NPI:1811172612
Name:EISENBARTH, STEPHANIE CAROLINE (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:CAROLINE
Last Name:EISENBARTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:CAROLINE
Other - Last Name:EISENBARTH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:251 E HURON ST STE 7-325
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2908
Mailing Address - Country:US
Mailing Address - Phone:312-926-7405
Mailing Address - Fax:312-926-3127
Practice Address - Street 1:251 E HURON ST STE 7-325
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-7405
Practice Address - Fax:312-926-3127
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046721207ZP0105X
IL036159286207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine