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Individual

THOMAS A. EISEMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
25 N WINFIELD ROAD, WINFIELD, IL 60190
(630) 933-4700
(630) 933-4721
Mailing address
25 N. WINFIELD ROAD, WINFIELD, IL 60190
(630) 933-4700
(630) 933-4721

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036102548
IL
207R00000X
Internal Medicine Physician
036102548
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0222075
BLUE CROSS GROUP ID
IL
05
036102548
IL
01
1033149844
GROUP NPI
IL
01
206147
MEDICARE GROUP PTAN
IL
01
3631498336019001
HFS GROUP PAYEE ID
IL
01
CA4748
MEDICARE RAILROAD PTAN (GROUP)
01
P00884750
MEDICARE RAILROAD PTAN (INDIVIDUAL)
Enumeration date
08/09/2005
Last updated
08/16/2017
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