Provider Demographics
NPI:1497924989
Name:HENRY W. MAICKI, M.D., PLLC
Entity Type:Organization
Organization Name:HENRY W. MAICKI, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MAICKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-471-4777
Mailing Address - Street 1:24353 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1917
Mailing Address - Country:US
Mailing Address - Phone:248-471-4777
Mailing Address - Fax:248-477-1613
Practice Address - Street 1:24353 ORCHARD LAKE RD
Practice Address - Street 2:SUITE E
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1917
Practice Address - Country:US
Practice Address - Phone:248-471-4777
Practice Address - Fax:248-477-1613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHM026513207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N39950OtherMEDICARE NUMBER
MI0N39950OtherMEDICARE NUMBER