Provider Demographics
NPI:1205889482
Name:HENRY, MITCHELL L (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:L
Last Name:HENRY
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 1:700 ACKERMAN RD
Mailing Address - Street 2:SUITE 570
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-6724
Mailing Address - Fax:614-293-4541
Practice Address - Street 1:770 KINNEAR ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212
Practice Address - Country:US
Practice Address - Phone:614-293-6724
Practice Address - Fax:614-293-4541
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044974204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP01138703OtherRAILROAD MEDICARE
OH0596298Medicaid
OH0596298Medicaid
OHHE0570644Medicare PIN