Basic Information
| Provider Information | |||||||||
| NPI: | 1821356759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EISENSTEIN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 843966 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641843966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738843300 | ||||||||
| FaxNumber: | 5738840943 | ||||||||
| Practice Location | |||||||||
| Address1: | 2707 W EDGEWOOD DR STE 102 | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 651095886 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5737611830 | ||||||||
| FaxNumber: | 5737611829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2012 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 2017005188 | MO | N | Allopathic & Osteopathic Physicians | Dermatology | 207NP0225X | 2017005188 | MO | Y | Allopathic & Osteopathic Physicians | Dermatology | Pediatric Dermatology |
No ID Information.