MEDICARE: ELIZABETH D ENNIS M.D.

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
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	15220	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346330669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH D ENNIS M.D.

Provider Business Mailing Address
First Line	:	3686 GRANDVIEW PKWY
Second Line	:	STE 810
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-3408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 MONTCLAIR RD
Second Line	:	SUITE 317
City	:	BIRMINGHAM
State	:	AL
Zip	:	35213-1920
Country	:	US
Telephone Number	:	205-592-5135
Fax Number	:	205-592-5694

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/15/2006
Last Update Date	:	02/21/2018

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