Jeff Ensroth
Individual provider Active NPI Counselor · Algonac, MI
NPI 1992801302 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992801302
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 6401008717 (MI)
- Practice address
- 555 Saint Clair River Dr
Algonac, MI 48001-1802 - Phone
- (810) 794-4982
- Fax
- (810) 794-4407
- NPI assigned
- Sep 15, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6401008717 | MI | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 6401008717 | MI | Yes |
Addresses
Primary practice location
555 Saint Clair River Dr
Algonac, MI 48001-1802
Mailing address
555 Saint Clair River Dr
Algonac, MI 48001-1802
Phone (810) 794-4982
Other providers in Algonac, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.