Basic Information
| Provider Information | |||||||||
| NPI: | 1659375020 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EISENBERG | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | COLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4671 GLEASON AVE | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342421310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413467679 | ||||||||
| FaxNumber: | 9363489143 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 MEDICAL BLVD | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342233964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004768646 | ||||||||
| FaxNumber: | 9193823210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2005 | ||||||||
| LastUpdateDate: | 06/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | ME0092155 | FL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | J6937 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | J6937 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | MD.021415 | LA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8BA390 | 01 | TX | BCBS | OTHER | 129389608 | 05 | TX | MEDICAID | 07749 | 01 | FL | BCBS | OTHER |