Provider Demographics
NPI:1942378757
Name:ENCINAS, DWIGHT DAVID E (MD)
Entity type:Individual
Prefix:
First Name:DWIGHT DAVID
Middle Name:E
Last Name:ENCINAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39393 VAN DYKE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-4636
Mailing Address - Country:US
Mailing Address - Phone:313-403-8787
Mailing Address - Fax:
Practice Address - Street 1:39393 VAN DYKE AVE STE 101
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-4636
Practice Address - Country:US
Practice Address - Phone:313-403-8787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE060797OtherCOMMERCIAL-COMMERCIAL NUMBER
080H262390OtherBLUE CROSS-BLUE CROSS
DE060797OtherCHAMPUS-CHAMPUS
MI322346710Medicaid
DE060797OtherCOMMERCIAL-COMMERCIAL NUMBER
DE060797OtherCHAMPUS-CHAMPUS