Provider Demographics
NPI:1548288723
Name:EISENBUD, ELLIOTT (MD)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:
Last Name:EISENBUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 MERCY CT STE 110
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3150
Mailing Address - Country:US
Mailing Address - Phone:916-966-5404
Mailing Address - Fax:916-966-0932
Practice Address - Street 1:6600 MERCY CT STE 110
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3150
Practice Address - Country:US
Practice Address - Phone:916-966-5404
Practice Address - Fax:916-966-0932
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23760207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G237600Medicaid
CA00G237600Medicaid