Provider Demographics
NPI:1255304085
Name:HENIKE, BARBARA (MD)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:
Last Name:HENIKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24001 GREATER MACK AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ST CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1407
Mailing Address - Country:US
Mailing Address - Phone:586-772-3244
Mailing Address - Fax:
Practice Address - Street 1:24001 GREATER MACK AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ST CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1407
Practice Address - Country:US
Practice Address - Phone:586-772-3244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010351312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382479136OtherTAX ID NUMBER