Provider Demographics
NPI:1386621415
Name:ENSERRO, RHONDA J (MD)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:J
Last Name:ENSERRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:974 73RD ST
Mailing Address - Street 2:SUITE 30
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50312-1024
Mailing Address - Country:US
Mailing Address - Phone:515-224-4993
Mailing Address - Fax:515-224-1505
Practice Address - Street 1:974 73RD ST
Practice Address - Street 2:SUITE 30
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50312-1024
Practice Address - Country:US
Practice Address - Phone:515-224-4993
Practice Address - Fax:515-224-1505
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2012-05-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA32900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1386621415Medicaid
IA370013577OtherRR MEDICARE
IA0190801Medicaid
IA370013577OtherRR MEDICARE
IAG91762Medicare UPIN