MEDICARE: SOL ALLAN ENRIQUEZ

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	2004019500	MO
2	208M00000X	Hospitalist Physician	2004019500	MO

General Provider Information

NPI Number	:	1699769356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOL ALLAN ENRIQUEZ

Provider Business Mailing Address
First Line	:	PO BOX 419380
Second Line	:	DEPT. 235
City	:	KANSAS CITY
State	:	MO
Zip	:	64141-6380
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3980 SOUTH JACKSON DR.
Second Line	:
City	:	INDEPENDENCE
State	:	MO
Zip	:	64057
Country	:	US
Telephone Number	:	816-795-1443
Fax Number	:

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

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	04/08/2019

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