Individual
CHARLES NICHOLAS EISENHAUER IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6029 WALNUT GROVE RD STE 404, MEMPHIS, TN 38120-2112
(901) 726-1056
Mailing address
300 S BRUCE ST, MARSHALL, MN 56258-1934
(507) 537-9165
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
57079
TN
208600000X
Surgery Physician
Primary
71735
MN
208600000X
Surgery Physician
P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0148667
—
OH
01
—
48491
KY STATE LICENSE
KY
01
—
57079
TN STATE LICENSE
TN
05
—
7100133120
—
KY
Enumeration date
04/01/2009
Last updated
07/05/2022
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