Provider Demographics
NPI:1922089598
Name:DOHRENWEND, MICHAEL PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATRICK
Last Name:DOHRENWEND
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 1:420 LOWELL DR SE
Mailing Address - Street 2:STE 103
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3754
Mailing Address - Country:US
Mailing Address - Phone:256-535-5940
Mailing Address - Fax:256-535-5954
Practice Address - Street 1:7738 MADISON BLVD
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2085
Practice Address - Country:US
Practice Address - Phone:256-430-4427
Practice Address - Fax:256-430-4335
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16209207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
331103393OtherTAX IDENTIFICATION NO
AL51525690OtherBLUE CROSS BLUE SHIELD
AL051525690Medicaid
0007315194OtherAETNA IDENTIFICATION NO
0007315194OtherAETNA IDENTIFICATION NO
331103393OtherTAX IDENTIFICATION NO
P00191917Medicare ID - Type UnspecifiedRAILROAD MEDICARE