Individual
MR. CHAD P ENICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA C
Contact information
Practice address
2901 86TH ST, URBANDALE, IA 50322-4201
(515) 276-3406
(515) 276-5141
Mailing address
2901 86TH ST, URBANDALE, IA 50322-4201
(515) 276-3406
(515) 276-5141
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
001165
IA
207Q00000X
Family Medicine Physician
01165
IA
363A00000X
Physician Assistant
Primary
001165
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174510879
—
IA
05
—
2133348
—
IA
01
—
44593
BCBS
—
01
—
970009403
RAILROAD MEDICARE
IA
01
—
P01396066
RR MEDICARE
IA
Enumeration date
09/29/2005
Last updated
05/24/2022
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