Provider Demographics
NPI:1568482446
Name:HENDRICKS, MICHAEL W (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:W
Last Name:HENDRICKS
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 1:903 OAK ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-4608
Mailing Address - Country:US
Mailing Address - Phone:319-758-9133
Mailing Address - Fax:319-758-9143
Practice Address - Street 1:903 OAK ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-4608
Practice Address - Country:US
Practice Address - Phone:319-758-9133
Practice Address - Fax:319-758-9143
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26178174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA46204OtherBLUE CROSS BLUE SHEILD
IA1043539Medicaid
IAA03411Medicare UPIN
IAA03411Medicare UPIN