Provider Demographics
NPI:1962671388
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:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:NAEIM
Authorized Official - Last Name:HENEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-312-9300
Mailing Address - Street 1:75 BARCLAY CIRCLE
Mailing Address - Street 2:SUITE 118
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-312-9300
Mailing Address - Fax:586-776-8410
Practice Address - Street 1:75 BARCLAY CIRCLE
Practice Address - Street 2:SUITE 118
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-312-9300
Practice Address - Fax:586-776-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI061311208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4121120Medicaid
OM61690Medicare PIN
MI4121120Medicaid