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NPI Code Detail

MEDICARE: RICHARD DAVID ENTZ MD

MEDICARE: RICHARD DAVID ENTZ MD
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
1207R00000XInternal Medicine Physician4301049721MI

Other Identifiers

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

General Provider Information

NPI Number : 1407854185
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD DAVID ENTZ MD
Provider Business Mailing Address
First Line : 1105 SIXTH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-2345
Country : US
Telephone Number : 231-935-6370
Fax Number : 231-935-6451
Provider Business Practice Location Address
First Line : 1105 SIXTH ST
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-2345
Country : US
Telephone Number : 231-935-6370
Fax Number : 231-935-6451
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2005
Last Update Date : 06/09/2022

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