Individual
DR. ENZO ANTHONY CENTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M D
Contact information
Practice address
925 E 67TH ST, INDIANAPOLIS, IN 46220-1197
(317) 840-1913
Mailing address
3264 N EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9746
(616) 363-7339
(616) 361-5828
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01068160
IN
2085R0202X
Diagnostic Radiology Physician
036-117107
IL
2085R0202X
Diagnostic Radiology Physician
239006
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000662355
BCBS
IN
05
—
200980980
—
IN
01
—
P00844119
RR MEDICARE
IN
Enumeration date
05/06/2008
Last updated
05/16/2012
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