Healthcare Provider Details

I. General information

NPI: 1336124262
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER HENRY IDHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

2703 MARTIN LUTHER KING JR AVE SE STOP 7201
WASHINGTON DC
20593-7201
US

V. Phone/Fax

Practice location:
  • Phone: 202-372-4100
  • Fax:
Mailing address:
  • Phone: 202-372-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: