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NPI Code Detail

MEDICARE: AUDREY ENERSON MD

MEDICARE:   AUDREY  ENERSON  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
1390200000XStudent in an Organized Health Care Education/Training Program4351055939MI

General Provider Information

NPI Number : 1790615011
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY ENERSON MD
Provider Business Mailing Address
First Line : 1000 OAKLAND DR
Second Line :
City : KALAMAZOO
State : MI
Zip : 49008-1282
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1000 OAKLAND DR
Second Line :
City : KALAMAZOO
State : MI
Zip : 49008-1282
Country : US
Telephone Number : 269-337-4600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2026
Last Update Date : 05/26/2026

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