Provider Demographics
NPI:1790724417
Name:HENIFF, MICHAEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:W
Last Name:HENIFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11824 SOUTHWEST HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1055
Mailing Address - Country:US
Mailing Address - Phone:708-277-6150
Mailing Address - Fax:708-277-6110
Practice Address - Street 1:11824 SOUTHWEST HWY
Practice Address - Street 2:SUITE 130
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1055
Practice Address - Country:US
Practice Address - Phone:708-277-6150
Practice Address - Fax:708-277-6110
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036081840207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081840OtherMEDICAID
IL290013000OtherPALMETTO RR MEDICARE
ILL77259Medicare PIN