Provider Demographics
NPI:1962490441
Name:ENDRES, TERRENCE J (MD)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:J
Last Name:ENDRES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1111 LEFFINGWELL AVE NE
Mailing Address - Street 2:STE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525
Mailing Address - Country:US
Mailing Address - Phone:616-459-7101
Mailing Address - Fax:616-464-6170
Practice Address - Street 1:1111 LEFFINGWELL AVE NE
Practice Address - Street 2:STE 100
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-459-7101
Practice Address - Fax:616-464-6170
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2016-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301070789207X00000X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00043519OtherRR MEDICARE
P00043519OtherRR MEDICARE
0D14869020Medicare PIN
MI0D14869Medicare ID - Type Unspecified