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Individual
DR. TAMMY LYNN EISENTROUT
Active
Individual
DR. TAMMY LYNN EISENTROUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34007772E
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000328557
UNICARE PROVIDER #
OH
01
—
200830551028
CARESOURCE PROVIDER #
OH
05
—
2430640
—
OH
01
—
733255
BUCKEY PROVIDER #
OH
01
—
P00221584
RAILROAD MEDICARE PROVIDE
OH
Enumeration date
04/19/2006
Last updated
07/20/2016
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