Provider Demographics
NPI:1518166354
Name:HENDERSON, MICHAEL DWAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DWAYNE
Last Name:HENDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 SAINT MARKS PL STE 160
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-1253
Mailing Address - Country:US
Mailing Address - Phone:979-242-5677
Mailing Address - Fax:979-242-5680
Practice Address - Street 1:1900 SCENIC DR
Practice Address - Street 2:SUITE 3308
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7724
Practice Address - Country:US
Practice Address - Phone:512-869-2566
Practice Address - Fax:512-869-7434
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2022-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXQ9636207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease