Provider Demographics
NPI:1205818291
Name:HENKE, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:HENKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5315 ELLIOTT DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-8634
Mailing Address - Country:US
Mailing Address - Phone:734-712-0655
Mailing Address - Fax:734-712-0611
Practice Address - Street 1:5315 ELLIOTT DR
Practice Address - Street 2:SUITE 304
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-8634
Practice Address - Country:US
Practice Address - Phone:734-712-0655
Practice Address - Fax:734-712-0611
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-03-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301029418207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4774270Medicaid
MI102091OtherCARE CHOICES
MI2008174821OtherBLUE CROSS BLUE SHIELD
MI102091OtherCARE CHOICES
MI2008174821OtherBLUE CROSS BLUE SHIELD