Individual
GREGORY G ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4100 COVERT AVE, EVANSVILLE, IN 47714-5559
(812) 476-9983
(812) 476-3809
Mailing address
PO BOX 3276, EVANSVILLE, IN 47731-3276
(812) 473-0181
(812) 473-5822
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
01051903A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000078150
BCBS PIN
IN
01
—
064756
HAMP PIN
IN
01
—
145885
UMWA PIN
IN
01
—
1761906
FIRST HEALTH PIN
IN
01
—
423127
HEALTHLINK NONPAR PIN
IN
01
—
610186900
FECA PIN
IN
05
—
64003460
—
KY
Enumeration date
09/22/2006
Last updated
04/20/2011
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