Provider Demographics
NPI:1689603961
Name:HENES, CHRISTOPHER GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:GREGORY
Last Name:HENES
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:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:6420 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3372
Practice Address - Country:US
Practice Address - Phone:502-891-8300
Practice Address - Fax:502-891-8338
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27958207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00893025OtherRAILROAD MEDICARE - NCVA
IN100388780FMedicaid
KY2433837000OtherPASSPORT ADVANTAGE PIN
KY000000044880OtherANTHEM PIN
KY000000693026OtherANTHEM - NCVA
KY000057080GOtherHUMANA - NCVA
IN100388780AMedicaid
KY50031404OtherPASSPORT & PASSPORT ADVTG - NCVA
KY64279581Medicaid
KY1056112OtherPASSPORT PIN
KY50031404OtherPASSPORT & PASSPORT ADVTG - NCVA
KY000000693026OtherANTHEM - NCVA
KY2433837000OtherPASSPORT ADVANTAGE PIN
KY0558303Medicare ID - Type Unspecified
KY64279581Medicaid
KY1271819Medicare ID - Type Unspecified
KY060018532Medicare PIN
KY060049842Medicare PIN