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NPI Code Detail

MEDICARE: PHILIP E HENDERSON MD

MEDICARE: PHILIP E HENDERSON 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
1207R00000XInternal Medicine Physician4301052857MI
2208000000XPediatrics Physician4301052857MI

General Provider Information

NPI Number : 1225032709
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILIP E HENDERSON MD
Provider Business Mailing Address
First Line : 100 MICHIGAN ST NE # MC845
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8501 MEADOW CRK
Second Line :
City : ROCKFORD
State : MI
Zip : 49341-7524
Country : US
Telephone Number : 616-267-7884
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 01/05/2026

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