Provider Demographics
NPI:1447231642
Name:HENELT, ANN LOUISE (DO)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LOUISE
Last Name:HENELT
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 1:1301 BERTHA HOWE AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MESQUITE
Mailing Address - State:NV
Mailing Address - Zip Code:89027-7502
Mailing Address - Country:US
Mailing Address - Phone:702-346-1700
Mailing Address - Fax:702-346-3563
Practice Address - Street 1:1301 BERTHA HOWE AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-7502
Practice Address - Country:US
Practice Address - Phone:702-346-1700
Practice Address - Fax:702-346-3563
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAH010464208600000X
NVDO1535208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI020026511OtherRAILROAD MEDICARE
MIP82550OtherBLUE CARE NETWORK
MI17-31077OtherPHP PROVIDER #
MI9961OtherCOMMUNITY CHOICE MI
MIAH010464OtherSTATE LICENSE #
MI3013361Medicaid
MI0250306465OtherBCBS MI PROV #
MI1836555OtherUNITED HEALTHCARE
MI21618OtherHEALTH PLAN OF MI
MIP39040003Medicare PIN
MIAH010464OtherSTATE LICENSE #
MI21618OtherHEALTH PLAN OF MI