Healthcare Provider Details

I. General information

NPI: 1518961903
Provider Name (Legal Business Name): ANTHONY J SENAGORE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 S WASHINGTON AVE STE. 1
SAGINAW MI
48601-2564
US

IV. Provider business mailing address

912 S WASHINGTON AVE STE. 1
SAGINAW MI
48601-2564
US

V. Phone/Fax

Practice location:
  • Phone: 989-790-1001
  • Fax: 989-790-1002
Mailing address:
  • Phone: 989-790-1001
  • Fax: 989-790-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35075613
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC51076
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35075613
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberC51076
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number4301045625
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: