Provider Demographics
NPI:1992708002
Name:ENYENIHI, HENRY NUBUNG (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:NUBUNG
Last Name:ENYENIHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11121 HIGHWAY 70 STE 101
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-9230
Mailing Address - Country:US
Mailing Address - Phone:901-867-0211
Mailing Address - Fax:901-867-0759
Practice Address - Street 1:11121 HIGHWAY 70
Practice Address - Street 2:SUITE 101
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-9230
Practice Address - Country:US
Practice Address - Phone:901-867-0211
Practice Address - Fax:901-867-0759
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN29373207R00000X, 208M00000X
CAA50281208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4126386OtherBLUE CROSS BLUE SHIELD OF TN
TN3842358Medicaid
3842355Medicare PIN
TNF74326Medicare UPIN
TN3842358Medicare PIN
F74326Medicare UPIN