Provider Demographics
NPI:1588666838
Name:HENNESSY, JAMES ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROBERT
Last Name:HENNESSY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:BOX 472
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-4022
Mailing Address - Country:US
Mailing Address - Phone:419-936-6929
Mailing Address - Fax:419-251-7761
Practice Address - Street 1:2222 CHERRY ST
Practice Address - Street 2:STE 2800
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2675
Practice Address - Country:US
Practice Address - Phone:419-936-6929
Practice Address - Fax:419-251-7761
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH350430542080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35043054Medicaid
OH35043054Medicaid