Provider Demographics
NPI:1902850472
Name:HUMBLES, ENOS MARCUS (DO)
Entity Type:Individual
Prefix:DR
First Name:ENOS
Middle Name:MARCUS
Last Name:HUMBLES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
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:313-535-7880
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114506064Medicaid
MI114537712Medicaid
MI5101011834OtherSTATE OF MICHIGAN LICENSE
MIEH011838OtherBCBS
MIP31038FOtherBLUE CARE NETWORK
MI1891935656OtherGROUP NPI FOR REDFORD URGENT CARE MEDICAL CLINIC
MIP31038FOtherBLUE CARE NETWORK
MI5101011834OtherSTATE OF MICHIGAN LICENSE
MI0N71650Medicare UPIN
MI114506064Medicaid