Provider Demographics
NPI:1447259015
Name:EISENSTEIN, STEVEN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:EISENSTEIN
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 1:1885 SHERMER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5317
Mailing Address - Country:US
Mailing Address - Phone:847-272-4600
Mailing Address - Fax:847-272-4655
Practice Address - Street 1:1885 SHERMER RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5317
Practice Address - Country:US
Practice Address - Phone:847-272-4600
Practice Address - Fax:847-272-4655
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036078149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078149OtherSTATE LICENSE
IL036078149Medicaid
ILE05740Medicare UPIN
IL901061Medicare ID - Type Unspecified