Basic Information
| Provider Information | |||||||||
| NPI: | 1700863925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EISENSTEIN | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 METTAWA LANE | ||||||||
| Address2: | SUITE N500 | ||||||||
| City: | RIVERWOODS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600153551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144554780 | ||||||||
| FaxNumber: | 4144752936 | ||||||||
| Practice Location | |||||||||
| Address1: | 720 E ROLLINS RD | ||||||||
| Address2: | 5 METTAWA LANE | ||||||||
| City: | RIVERWOODS | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600153551 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475463600 | ||||||||
| FaxNumber: | 8475463633 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 04/29/2011 | ||||||||
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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 | 2085R0202X | 036072680 | IL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 036072680 | 05 | IL | MEDICAID |