Provider Demographics
NPI:1568492015
Name:HENDRICK, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:HENDRICK
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 1:1900 GARDEN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-5334
Mailing Address - Country:US
Mailing Address - Phone:831-375-4945
Mailing Address - Fax:831-375-4779
Practice Address - Street 1:1900 GARDEN RD STE 100
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5334
Practice Address - Country:US
Practice Address - Phone:831-375-4945
Practice Address - Fax:831-375-4779
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H46899Medicare UPIN
00A763090Medicare ID - Type Unspecified