Basic Information
Provider Information | |||||||||
NPI: | 1124049564 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | EISINGER | ||||||||
FirstName: | LAWRENCE | ||||||||
MiddleName: | F. | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 712 SOUTH CASCADE STREET | ||||||||
Address2: |   | ||||||||
City: | FERGUS FALLS | ||||||||
State: | MN | ||||||||
PostalCode: | 565372813 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2187368000 | ||||||||
FaxNumber: | 2187368757 | ||||||||
Practice Location | |||||||||
Address1: | 712 SOUTH CASCADE STREET | ||||||||
Address2: |   | ||||||||
City: | FERGUS FALLS | ||||||||
State: | MN | ||||||||
PostalCode: | 565372813 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2187368000 | ||||||||
FaxNumber: | 2187368757 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/21/2006 | ||||||||
LastUpdateDate: | 08/11/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 23513 | MN | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | NCMA7610129 | 05 | AK |   | MEDICAID | 61166EI | 01 | MN | BCBS NUMBER | OTHER | HP26507 | 01 | MN | HEALTHPARTNERS NUMBER | OTHER | 114376 | 01 | MN | UCARE NUMBER | OTHER | 41091744413 | 05 | NE |   | MEDICAID | 10717 | 05 | ND |   | MEDICAID | 4109174445353701 | 05 | IL |   | MEDICAID | 0561449 | 05 | IA |   | MEDICAID | 733892900 | 05 | MN |   | MEDICAID | 1008969 | 01 | MN | PREFERRED ONE NUMBER | OTHER | 12-00187 | 01 | MN | MEDICA NUMBER | OTHER |