Individual
DIANA ENNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
110 BEECH ST, TAWAS CITY, MI 48763-8314
(989) 362-9859
(989) 362-9862
Mailing address
PO BOX 779, TAWAS CITY, MI 48764-0779
(989) 362-9859
(989) 362-9862
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
4301044652
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3370220
—
MI
Enumeration date
10/11/2005
Last updated
08/07/2017
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