Provider Demographics
NPI:1336700038
Name:ENRIQUEZ, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:ENRIQUEZ
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:UF PEDIATRIC RESIDENCY @ SACRED HEART HOSPITAL
Mailing Address - Street 2:5151 NORTH 9TH AVE, 1ST FLOOR MEDSTAFF/GME
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504
Mailing Address - Country:US
Mailing Address - Phone:850-941-7841
Mailing Address - Fax:850-332-0155
Practice Address - Street 1:FAIRFIELD PEDIATRICS- COMMUNITY HEALTH NW FL
Practice Address - Street 2:1295 W FAIRFIELD DRIVE
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501
Practice Address - Country:US
Practice Address - Phone:850-941-7841
Practice Address - Fax:850-332-0155
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN28951390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program