Individual
DR. MICHAEL C. ENNIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
279 LINCOLN ST, HAHNEMANN FAMILY HEALTH CENTER, WORCESTER, MA 01605-2120
(508) 334-8830
(508) 334-8835
Mailing address
PO BOX 415348, BOSTON, MA 02241-5347
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
53353
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3006131
—
MA
Enumeration date
10/24/2005
Last updated
12/16/2020
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