MEDICARE: MALCOLM HENOCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	4301077215	MI

General Provider Information

NPI Number	:	1154301018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALCOLM HENOCH MD

Provider Business Mailing Address
First Line	:	15492 BAY HILL DR
Second Line	:
City	:	NORTHVILLE
State	:	MI
Zip	:	48168-8474
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18181 OAKWOOD BLVD
Second Line	:	SUITE 402
City	:	DEARBORN
State	:	MI
Zip	:	48124-5032
Country	:	US
Telephone Number	:	313-996-7380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	10/18/2011

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