Provider Demographics
NPI:1750350286
Name:SENNISH, JOHN CLEARY (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CLEARY
Last Name:SENNISH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:360 E CHICAGO ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-2086
Mailing Address - Country:US
Mailing Address - Phone:517-279-4720
Mailing Address - Fax:517-279-4882
Practice Address - Street 1:360 E CHICAGO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2086
Practice Address - Country:US
Practice Address - Phone:517-279-4720
Practice Address - Fax:517-279-4882
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2010-08-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301043259208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3113803Medicaid
MI01200054023Medicare ID - Type Unspecified
MI3113803Medicaid