Provider Demographics
NPI:1659342079
Name:ENAD, RAUL G (MD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:G
Last Name:ENAD
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 1:5080 ANNUNCIATION CIR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-9655
Mailing Address - Country:US
Mailing Address - Phone:239-322-0917
Mailing Address - Fax:239-658-5143
Practice Address - Street 1:5080 ANNUNCIATION CIR UNIT 103
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-9655
Practice Address - Country:US
Practice Address - Phone:239-322-0917
Practice Address - Fax:239-658-5143
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL120846207R00000X
MO2005031797207R00000X
IN01071642A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01122801OtherMEDICARE RR
IN201116290Medicaid
IN616679523OtherDEPARTMENT OF LABOR
INP01122801OtherMEDICARE RR
INM471400033Medicare PIN