Healthcare Provider Details

I. General information

NPI: 1477714822
Provider Name (Legal Business Name): CHRISTOPHER DALE HENLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2008
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5129 DIXIE HWY STE 100
LOUISVILLE KY
40216-1727
US

IV. Provider business mailing address

680 N LAKE SHORE DR STE 1000 NORTHWESTERN MEMORIAL HOSPITAL
CHICAGO IL
60611-8709
US

V. Phone/Fax

Practice location:
  • Phone: 502-447-8786
  • Fax: 502-447-8623
Mailing address:
  • Phone: 312-472-0436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number53172
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberTP635
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: