MEDICARE: MICHAEL PATRICK DOHRENWEND 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	207RG0100X	Gastroenterology Physician	16209	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	331103393	OTHER		TAX IDENTIFICATION NO
2	51525690	OTHER	AL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0007315194	OTHER		AETNA IDENTIFICATION NO

General Provider Information

NPI Number	:	1922089598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL PATRICK DOHRENWEND MD

Provider Business Mailing Address
First Line	:	420 LOWELL DR SE
Second Line	:	STE 103
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-3754
Country	:	US
Telephone Number	:	256-535-5940
Fax Number	:	256-535-5954

Provider Business Practice Location Address
First Line	:	7738 MADISON BLVD
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-2085
Country	:	US
Telephone Number	:	256-430-4427
Fax Number	:	256-430-4335

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	12/07/2009

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