Provider Demographics
NPI:1114966744
Name:HENDRIXSON, MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:HENDRIXSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 VICTORY PARKWAY
Mailing Address - Street 2:PAYOR ENROLLMENT
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1785
Mailing Address - Country:US
Mailing Address - Phone:513-585-5507
Mailing Address - Fax:
Practice Address - Street 1:7675 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2509
Practice Address - Country:US
Practice Address - Phone:513-475-7700
Practice Address - Fax:513-475-7738
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006426207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2021743Medicaid
OHG40401Medicare UPIN
OH2021743Medicaid
OH0814873Medicare PIN