Provider Demographics
NPI:1881734143
Name:JULIE L. HENRY, M.D, P.C.
Entity type:Organization
Organization Name:JULIE L. HENRY, M.D, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-574-4417
Mailing Address - Street 1:27427 SCHOENHERR RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-4729
Mailing Address - Country:US
Mailing Address - Phone:586-547-4417
Mailing Address - Fax:586-574-4473
Practice Address - Street 1:27427 SCHOENHERR RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4729
Practice Address - Country:US
Practice Address - Phone:586-547-4417
Practice Address - Fax:586-574-4473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301066091207X00000X, 204C00000X
4876080001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG76233Medicare UPIN
MI0N68090Medicare PIN
4876080001Medicare NSC