Provider Demographics
NPI:1598760688
Name:BONE, HENRY GRADY III (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:GRADY
Last Name:BONE
Suffix:III
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 1:22201 MOROSS RD
Mailing Address - Street 2:STE 260
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2175
Mailing Address - Country:US
Mailing Address - Phone:313-640-7700
Mailing Address - Fax:313-640-1740
Practice Address - Street 1:22201 MOROSS RD
Practice Address - Street 2:STE 260
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2175
Practice Address - Country:US
Practice Address - Phone:313-640-7700
Practice Address - Fax:313-640-1740
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010582239207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4090552Medicaid
MI4090552Medicaid
C46520Medicare UPIN