Teresa M Ennisdecker (NPI# 1154322956, PAC ID# 9830179258) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is OPTOMETRY.
| Nation Provider ID (NPI) | 1154322956 |
| PAC ID by PECOS | 9830179258 |
| Professional Enrollment ID | I20040724000270 |
| Full Name | Teresa M Ennisdecker |
| Address |
9575 S State Rd Millington MI 48746-9482 |
| Gender | F |
| Credential | OD |
| Medical School | ILLINOIS COLLEGE OF OPTOMETRY AT CHICAGO |
| Graduation Year | 1990 |
| Primary Specialty | OPTOMETRY |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 9575 S State Rd, Millington, MI 48746-9482 |
| Street Address |
9575 S STATE RD |
| City | MILLINGTON |
| State | MI |
| Zip | 48746-9482 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jennifer Lynn Smalley-huber | Optometry | Lakeville Eye Care Center Inc | 9575 S State Rd, Millington, MI 48746-9482 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Sridhar A Rao | Family Medicine | Ascension Medical Group Genesys | 9030 State Rd, Millington, MI 48746-8902 |
| City | MILLINGTON |
| Zip Code | 48746 |
| Specialty | OPTOMETRY |
| City + Specialty | MILLINGTON + OPTOMETRY |
Please comment or provide details below to improve the information on Teresa M Ennisdecker.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.