Provider Demographics
NPI:1003971839
Name:HENNIGAN, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:HENNIGAN
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 1:3 MEDICAL PARK
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1804
Mailing Address - Country:US
Mailing Address - Phone:251-929-4324
Mailing Address - Fax:251-279-3931
Practice Address - Street 1:3 MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-1804
Practice Address - Country:US
Practice Address - Phone:251-929-3424
Practice Address - Fax:251-279-3931
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133406207RE0101X
AK173573207RE0101X
AL00014952207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000081181OtherBCBS OF AL PROVIDER NUMBE
FL022091600Medicaid
AL000081181Medicaid
AL529910470Medicaid
ALC84459Medicare UPIN