Provider Demographics
NPI:1235564113
Name:BOODEE, HENRI WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRI
Middle Name:WILLIAM
Last Name:BOODEE
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 1:1146 S WAUKEGAN RD # 237
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-6731
Mailing Address - Country:US
Mailing Address - Phone:203-297-4567
Mailing Address - Fax:
Practice Address - Street 1:1146 S WAUKEGAN RD # 237
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-6731
Practice Address - Country:US
Practice Address - Phone:203-297-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.132689208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology