MEDICARE: GLEN ENZENBERGER 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
1	207Q00000X	Family Medicine Physician	5101010568	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	:	1639167471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLEN ENZENBERGER DO

Provider Business Mailing Address
First Line	:	700 GERMAN ST
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9349
Country	:	US
Telephone Number	:	989-362-4170
Fax Number	:	989-362-0034

Provider Business Practice Location Address
First Line	:	700 GERMAN ST
Second Line	:
City	:	TAWAS CITY
State	:	MI
Zip	:	48763-9349
Country	:	US
Telephone Number	:	989-362-4170
Fax Number	:	989-362-0034

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	04/06/2021

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Directions to “ GLEN ENZENBERGER DO” Practice Location

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