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General NPI Number Information
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NPI Number | 1992969950
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Entity Type | Individual
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Provider Name | DOMINGO LINAREZ ENRIQUEZ JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 1392 E LINCOLN ST
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City | BIRMINGHAM
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State | MI
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Zip | 48009-7192
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Country | US
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Telephone | 248-642-9781
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Fax | 248-642-9781
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Provider Business Mailing Address
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Address Line | 1392 E LINCOLN ST
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City | BIRMINGHAM
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State | MI
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Zip | 48009-7192
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Country | US
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Telephone | 248-642-9781
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Fax | 248-642-9781
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301031876
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License Number State | MI
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