MEDICARE: DR. JAMES ROBERT HENNESSY M.D.

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	2080P0202X	Pediatric Cardiology Physician	35043054	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588666838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES ROBERT HENNESSY M.D.

Provider Business Mailing Address
First Line	:	BOX 472
Second Line	:
City	:	MONROE
State	:	MI
Zip	:	48161-4022
Country	:	US
Telephone Number	:	419-936-6929
Fax Number	:	419-251-7761

Provider Business Practice Location Address
First Line	:	2222 CHERRY ST
Second Line	:	STE 2800
City	:	TOLEDO
State	:	OH
Zip	:	43608-2675
Country	:	US
Telephone Number	:	419-936-6929
Fax Number	:	419-251-7761

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	11/09/2009

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