MEDICARE: FRANK ANTWON HENRY

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	347C00000X	Private Vehicle	RT688041	OH

General Provider Information

NPI Number	:	1558185298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK ANTWON HENRY

Provider Business Mailing Address
First Line	:	5247 WILSON MILLS RD # 144
Second Line	:
City	:	RICHMOND HTS
State	:	OH
Zip	:	44143-3016
Country	:	US
Telephone Number	:	216-577-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	5247 WILSON MILLS RD # 144
Second Line	:
City	:	RICHMOND HTS
State	:	OH
Zip	:	44143-3016
Country	:	US
Telephone Number	:	216-577-0100
Fax Number	:

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

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	11/11/2024

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