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NPI Code Detail

MEDICARE: STUART ETENGOFF DO

MEDICARE: STUART ETENGOFF DO
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
1207P00000XEmergency Medicine Physician5101009547MI
2207PE0004XEmergency Medical Services (Emergency Medicine) Physician5101009547MI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5P00113859OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4SE009547OTHERBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1326021213
Entity Type Code : Individual
Provider Name (Legal Business Name) : STUART ETENGOFF DO
Provider Business Mailing Address
First Line : DEPT CH 17767
Second Line :
City : PALATINE
State : IL
Zip : 60055-0001
Country : US
Telephone Number : 800-968-6866
Fax Number :
Provider Business Practice Location Address
First Line : 1 GENESYS PKWY
Second Line :
City : GRAND BLANC
State : MI
Zip : 48439-8065
Country : US
Telephone Number : 810-606-6137
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/23/2005
Last Update Date : 03/06/2008

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Directions to “ STUART ETENGOFF DO” Practice Location

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