1891189171 NPI number — DR. WERNER HEINRICH HENNING D.O.

Table of content: DR. WERNER HEINRICH HENNING D.O. (NPI 1891189171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891189171 NPI number — DR. WERNER HEINRICH HENNING D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENNING
Provider First Name:
WERNER
Provider Middle Name:
HEINRICH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891189171
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2720 S WASHINGTON AVE
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48910-2202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-487-8255
Provider Business Mailing Address Fax Number:
517-487-2059

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1230 COLINBROOK CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46143-3608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-370-0157
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  5101022115 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)