Provider Demographics
NPI:1982704466
Name:EISENHUT, CAROL (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:EISENHUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CAROL
Other - Last Name:EISENHUT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M D
Mailing Address - Street 1:9550 ZIONSVILLE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1065
Mailing Address - Country:US
Mailing Address - Phone:317-872-0116
Mailing Address - Fax:317-874-1440
Practice Address - Street 1:10291 N MERIDIAN ST STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1000
Practice Address - Country:US
Practice Address - Phone:317-874-1254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036079207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036099414OtherLICENSE
IN01036079OtherLICENSE
OH35086530OtherLICENSE
IN100132730Medicaid
KY64130495Medicaid
IN255020BMedicare PIN
IN339270Medicare ID - Type Unspecified
ILK48628Medicare PIN
IN100132730Medicaid