Provider Demographics
NPI:1396803680
Name:CENTER FOR DIGESTIVE HEALTH
Entity type:Organization
Organization Name:CENTER FOR DIGESTIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:DOHRENWEND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-430-4427
Mailing Address - Street 1:420 LOWELL DRIVE SE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-535-5940
Mailing Address - Fax:256-535-5954
Practice Address - Street 1:7738 MADSON BOULEVARD
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806
Practice Address - Country:US
Practice Address - Phone:256-430-4427
Practice Address - Fax:256-430-4335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16209207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51525690OtherBLUE CROSS BLUE SHIELD
AL051525690Medicaid
K225OtherMEDICARE GROUP PIN
AL51525690OtherBLUE CROSS BLUE SHIELD
F29538Medicare UPIN