Provider Demographics
NPI:1578526034
Name:KANLIC, ENES M (MD)
Entity Type:Individual
Prefix:
First Name:ENES
Middle Name:M
Last Name:KANLIC
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 1:1877 N BAYSHORE DR
Mailing Address - Street 2:
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-6298
Mailing Address - Country:US
Mailing Address - Phone:480-669-3300
Mailing Address - Fax:
Practice Address - Street 1:1877 N BAYSHORE DR
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-6298
Practice Address - Country:US
Practice Address - Phone:480-669-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9311207X00000X
AZ50046207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ310402Medicaid
TXG05248Medicare UPIN
TX106250702Medicaid