Basic Information
| Provider Information | |||||||||
| NPI: | 1619368008 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | EISEN | ||||||||
| FirstName: | MATTHEW | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 512 S CEDAR BLUFF RD | ||||||||
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| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379223697 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634091724 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1560 E SHERMAN BLVD STE 9 | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494441867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316728643 | ||||||||
| FaxNumber: | 2316728651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2015 | ||||||||
| LastUpdateDate: | 04/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 52281 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.