Provider Demographics
NPI:1851743272
Name:HENEGHAN, MICHAEL ANTHONY BENEDICT (MBBCH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY BENEDICT
Last Name:HENEGHAN
Suffix:
Gender:M
Credentials:MBBCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13001 E 17TH AVE # F546
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2505
Mailing Address - Country:US
Mailing Address - Phone:720-432-0837
Mailing Address - Fax:
Practice Address - Street 1:13001 E 17TH AVE # F546
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2505
Practice Address - Country:US
Practice Address - Phone:720-432-0837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-09
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00638582084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry