Provider Demographics
NPI:1093771040
Name:ENAS, ENAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:ENAS
Middle Name:A
Last Name:ENAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 FAIRVIEW AVE
Mailing Address - Street 2:SUITE103
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2264
Mailing Address - Country:US
Mailing Address - Phone:630-960-1844
Mailing Address - Fax:630-852-0244
Practice Address - Street 1:4121 FAIRVIEW AVE
Practice Address - Street 2:SUITE103
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2264
Practice Address - Country:US
Practice Address - Phone:630-960-1844
Practice Address - Fax:630-852-0244
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-047389174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036047389Medicaid
ILC37141Medicare UPIN