Provider Demographics
NPI:1477714822
Name:HENLEY, CHRISTOPHER DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DALE
Last Name:HENLEY
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 1:680 N LAKE SHORE DR STE 1000
Mailing Address - Street 2:NORTHWESTERN MEMORIAL HOSPITAL
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-8709
Mailing Address - Country:US
Mailing Address - Phone:312-472-0436
Mailing Address - Fax:
Practice Address - Street 1:5129 DIXIE HWY STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1727
Practice Address - Country:US
Practice Address - Phone:502-447-8786
Practice Address - Fax:502-447-8623
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY531722085R0202X
KYTP6352085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100626610Medicaid