MEDICARE: DIANA ENNES 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
1	207X00000X	Orthopaedic Surgery Physician	4301044652	MI

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

General Provider Information

NPI Number	:	1508854860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA ENNES MD

Provider Business Mailing Address
First Line	:	PO BOX 779
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48764-0779
Country	:	US
Telephone Number	:	989-362-9859
Fax Number	:	989-362-9862

Provider Business Practice Location Address
First Line	:	110 BEECH ST
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-8314
Country	:	US
Telephone Number	:	989-362-9859
Fax Number	:	989-362-9862

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

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	08/07/2017

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Directions to “ DIANA ENNES MD” Practice Location

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