MEDICARE: HENRY NUBUNG ENYENIHI 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	207R00000X	Internal Medicine Physician	29373	TN
2	208M00000X	Hospitalist Physician	A50281	CA
3	208M00000X	Hospitalist Physician	29373	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4126386	OTHER	TN	BLUE CROSS BLUE SHIELD OF TN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992708002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY NUBUNG ENYENIHI MD

Provider Business Mailing Address
First Line	:	11121 HIGHWAY 70 STE 101
Second Line	:
City	:	ARLINGTON
State	:	TN
Zip	:	38002-9230
Country	:	US
Telephone Number	:	901-867-0211
Fax Number	:	901-867-0759

Provider Business Practice Location Address
First Line	:	11121 HIGHWAY 70
Second Line	:	SUITE 101
City	:	ARLINGTON
State	:	TN
Zip	:	38002-9230
Country	:	US
Telephone Number	:	901-867-0211
Fax Number	:	901-867-0759

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	12/04/2012

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