Provider Demographics
NPI:1629496427
Name:HENSON, KARL EVANS RIVERA (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL EVANS
Middle Name:RIVERA
Last Name:HENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KARL
Other - Middle Name:
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3990 JOHN R ST
Mailing Address - Street 2:5 HUDSON, ROOM 5910
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2018
Mailing Address - Country:US
Mailing Address - Phone:313-745-9649
Mailing Address - Fax:313-993-0302
Practice Address - Street 1:3990 JOHN R ST
Practice Address - Street 2:5 HUDSON, ROOM 5910
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2018
Practice Address - Country:US
Practice Address - Phone:313-745-9649
Practice Address - Fax:313-993-0302
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program