Provider Demographics
NPI:1891783494
Name:DUKE, HENRY MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:MICHAEL
Last Name:DUKE
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 1:6210 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-3111
Mailing Address - Country:US
Mailing Address - Phone:937-275-6647
Mailing Address - Fax:937-275-7643
Practice Address - Street 1:6210 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3111
Practice Address - Country:US
Practice Address - Phone:937-275-6647
Practice Address - Fax:937-275-7643
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-4327207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000012628OtherANTHEM
OH311159796028OtherCARESOURCE
OH0490115Medicaid
OH000000012628OtherANTHEM
OH311159796028OtherCARESOURCE