Individual
EDUARDO ALBERTO ENRIQUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P T PC
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5501004167
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10425482410
—
MI
01
—
383322512
COMMERCIAL
MI
01
—
650D657010
BLUE CROSS BLUE SHIELD
MI
Enumeration date
06/04/2007
Last updated
08/18/2010
Update your record
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