Healthcare Provider Details

I. General information

NPI: 1447439294
Provider Name (Legal Business Name): KMAK HENDRIX & MCNEELEY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST UNIVERSITY HEALTH CENTER, 4F
DETROIT MI
48201-2153
US

IV. Provider business mailing address

7148 RELIABLE PKWY
CHICAGO IL
60686-0071
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-0499
  • Fax: 810-833-8801
Mailing address:
  • Phone: 810-720-5715
  • Fax: 810-600-1597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: DR. SUSAN L. HENDRIX
Title or Position: OWNER
Credential: DO
Phone: 810-720-5715