Provider Demographics
NPI:1790927234
Name:MICHAEL N HENEIN MD PC
Entity Type:Organization
Organization Name:MICHAEL N HENEIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP-C
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HENEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-885-8589
Mailing Address - Street 1:62550 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48094-1325
Mailing Address - Country:US
Mailing Address - Phone:313-885-8589
Mailing Address - Fax:
Practice Address - Street 1:75 BARCLAY CIR STE 118
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5803
Practice Address - Country:US
Practice Address - Phone:248-312-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704190384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty