Provider Demographics
NPI:1013066406
Name:HENDRICKS, DAVID R (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12100 S BENZONIA TRL
Mailing Address - Street 2:SUITE D
Mailing Address - City:EMPIRE
Mailing Address - State:MI
Mailing Address - Zip Code:49630-8503
Mailing Address - Country:US
Mailing Address - Phone:231-326-3002
Mailing Address - Fax:231-326-3026
Practice Address - Street 1:153 1/2 E FRONT ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-5729
Practice Address - Country:US
Practice Address - Phone:231-941-6670
Practice Address - Fax:231-941-6675
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-08-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301038246207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4858998Medicaid
MI11-0-28-1081-1OtherBLUE CROSS BLUE SHIELD
MI4858998Medicaid