Individual
EHRENTRAUD JOHANNA EICHELBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
212 S FLORIDA ST, BUSHNELL, FL 33513-6703
(352) 793-2441
(352) 793-3282
Mailing address
1113 LATTIMORE DR, CLERMONT, FL 34711-9032
(941) 779-4869
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
18573
PR
208D00000X
General Practice Physician
Primary
ME140028
FL
246ZS0410X
Surgical Technologist
238000185
IL
Other
Enumeration date
01/30/2008
Last updated
06/05/2019
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