Provider Demographics
NPI:1750510624
Name:HENCKEL, RONALD BRANDON (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:BRANDON
Last Name:HENCKEL
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 1:2900 12TH AVE N STE 204E
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7502
Mailing Address - Country:US
Mailing Address - Phone:406-237-5001
Mailing Address - Fax:406-237-5010
Practice Address - Street 1:2900 12TH AVE N STE 204E
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7502
Practice Address - Country:US
Practice Address - Phone:406-237-5001
Practice Address - Fax:406-237-5010
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-57826207RI0011X
MI4301094552390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty