Provider Demographics
NPI:1427193036
Name:HENEIN, CAROLINE N (DO)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:N
Last Name:HENEIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 OAKWOOD BLVD
Mailing Address - Street 2:P.O. BOX 2802
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2319
Mailing Address - Country:US
Mailing Address - Phone:313-359-7650
Mailing Address - Fax:
Practice Address - Street 1:840 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2319
Practice Address - Country:US
Practice Address - Phone:313-359-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010152442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4985524Medicaid
MI4985515Medicaid
MIH26272068Medicare PIN
MII72182Medicare UPIN
MIH26274066Medicare PIN