Provider Demographics
NPI:1275620635
Name:HENEIN, MICHAEL NAEIM (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NAEIM
Last Name:HENEIN
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 1:75 BARCLAY CIRCLE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-312-9300
Mailing Address - Fax:586-776-8410
Practice Address - Street 1:75 BARCLAY CIR STE 118
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5803
Practice Address - Country:US
Practice Address - Phone:248-312-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI061311208C00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4121120Medicaid
MIG73595Medicare UPIN
MIOM61690Medicare ID - Type Unspecified