Provider Demographics
NPI:1053308395
Name:EIBEN, CARL F (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:F
Last Name:EIBEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:850 WEST BARAGA AVENUE SUITE #30
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-225-3914
Mailing Address - Fax:906-225-4583
Practice Address - Street 1:850 WEST BARAGA AVENUE SUITE #30
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-225-3914
Practice Address - Fax:906-225-4583
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI044014208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2900018Medicaid
MI250E26047OtherBLUE CROSS BLUE SHIELD MI
CN0734Medicare PIN
MIB43244Medicare UPIN