MEDICARE: DR. MICHAEL R ENRICO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	61281	MN
2	207V00000X	Obstetrics & Gynecology Physician	MD-56313	IA
3	207V00000X	Obstetrics & Gynecology Physician	333055	NY

General Provider Information

NPI Number	:	1912960006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL R ENRICO MD

Provider Business Mailing Address
First Line	:	127 RED OAK DR
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-8996
Country	:	US
Telephone Number	:	775-354-5697
Fax Number	:

Provider Business Practice Location Address
First Line	:	6451 N FEDERAL HWY STE 800
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1409
Country	:	US
Telephone Number	:	954-837-2362
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	02/23/2026

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