Healthcare Provider Details

I. General information

NPI: 1891935656
Provider Name (Legal Business Name): DR ENOS MARCUS HUMBLES D.O. LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23405 PLYMOUTH RD
REDFORD MI
48239-1433
US

IV. Provider business mailing address

23405 PLYMOUTH RD
REDFORD MI
48239-1433
US

V. Phone/Fax

Practice location:
  • Phone: 313-535-7880
  • Fax: 313-535-8388
Mailing address:
  • Phone:
  • Fax: 313-535-8388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number5101011838
License Number StateMI

VIII. Authorized Official

Name: DR. ENOS MARCUS HUMBLES
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: D.O.
Phone: 313-535-7880