Provider Demographics
NPI:1881653277
Name:HENAO, ESTEBAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTEBAN
Middle Name:A
Last Name:HENAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:STEVE
Other - Middle Name:
Other - Last Name:HENAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:345 W STEAMBOAT DR
Mailing Address - Street 2:STE 601
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5287
Mailing Address - Country:US
Mailing Address - Phone:605-217-5610
Mailing Address - Fax:605-217-5533
Practice Address - Street 1:502 ELM ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2512
Practice Address - Country:US
Practice Address - Phone:505-841-1000
Practice Address - Fax:505-843-2592
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE337562086S0129X
NMMD2006-0041208G00000X, 2086S0129X
SD126962086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPENDINGMedicare UPIN