Provider Demographics
NPI:1205229176
Name:HENNING, EMILY (DO)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HENNING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:FAUTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3955 PATIENT CARE DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4299
Mailing Address - Country:US
Mailing Address - Phone:517-374-7600
Mailing Address - Fax:
Practice Address - Street 1:1650 HASLETT RD
Practice Address - Street 2:
Practice Address - City:HASLETT
Practice Address - State:MI
Practice Address - Zip Code:48840-7615
Practice Address - Country:US
Practice Address - Phone:517-853-5576
Practice Address - Fax:517-853-5577
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5101024593207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program