Provider Demographics
NPI:1891935656
Name:DR ENOS MARCUS HUMBLES D.O. LLC
Entity Type:Organization
Organization Name:DR ENOS MARCUS HUMBLES D.O. LLC
Other - Org Name:REDFORD URGENT CARE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ENOS
Authorized Official - Middle Name:MARCUS
Authorized Official - Last Name:HUMBLES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:313-535-7880
Mailing Address - Street 1:23405 PLYMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:313-535-8388
Practice Address - Street 1:23405 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239-1433
Practice Address - Country:US
Practice Address - Phone:313-535-7880
Practice Address - Fax:313-535-8388
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REDFORD URGENT CARE MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-05
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011838208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114506064Medicaid
MI1891935656OtherGROUP NPI NUMBER
1902850472OtherNPI
MI5101011838OtherSTATE OF MICHIGAN
MI114506064Medicaid
MI5101011838OtherSTATE OF MICHIGAN