Provider Demographics
NPI:1376566265
Name:HENNEY, FREDERIC ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERIC
Middle Name:ALAN
Last Name:HENNEY
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 1:810 S 6TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-8201
Mailing Address - Country:US
Mailing Address - Phone:574-583-6446
Mailing Address - Fax:574-583-3060
Practice Address - Street 1:810 S 6TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-8201
Practice Address - Country:US
Practice Address - Phone:574-583-6446
Practice Address - Fax:574-583-3060
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030491207L00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN080004174OtherMEDICARE RAILROAD
IN100079510Medicaid
B29739Medicare UPIN
IN866340Medicare ID - Type Unspecified