Provider Demographics
NPI:1235227950
Name:EISENMANN, DEBORAH LYNN (MD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:EISENMANN
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 1:2591 S LEATON RD
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-775-4603
Mailing Address - Fax:989-775-4680
Practice Address - Street 1:2591 S LEATON RD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-775-4603
Practice Address - Fax:989-775-4680
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDE055682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0370609OtherBCBS PPO PIN
G05822OtherBCN GROUP
MI2854523Medicaid
G05822OtherBCN GROUP
0370609OtherBCBS PPO PIN
E64370Medicare UPIN