Provider Demographics
NPI:1235484718
Name:MYRIAM ENSLING, M.D., LLC
Entity Type:Organization
Organization Name:MYRIAM ENSLING, M.D., LLC
Other - Org Name:DR. MYRIAM ENSLING INTERNAL MEDICINE AND OBESITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER/PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:ENSLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-442-2083
Mailing Address - Street 1:1502 E BROADWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8076
Mailing Address - Country:US
Mailing Address - Phone:573-442-2083
Mailing Address - Fax:573-442-9338
Practice Address - Street 1:1502 E BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8076
Practice Address - Country:US
Practice Address - Phone:573-442-2083
Practice Address - Fax:573-442-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003016643207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty