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General NPI Number Information
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NPI Number | 1396837233
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Entity Type | Organization
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Legal Business Name | CHILDREN'S MEDICINE P.C.
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1428 W MILHAM AVE
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City | PORTAGE
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State | MI
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Zip | 49024-1209
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Country | US
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Telephone | 269-345-9030
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Fax |
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Provider Business Mailing Address
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Address Line | 1818 FOREST DR
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City | PORTAGE
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State | MI
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Zip | 49002-6433
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Country | US
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Telephone | 269-323-0975
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT CARL ENSFIELD
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Credential | M.D.
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Telephone | 269-345-9030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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