Healthcare Provider Details

I. General information

NPI: 1881734143
Provider Name (Legal Business Name): JULIE L. HENRY, M.D, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27427 SCHOENHERR RD SUITE 200
WARREN MI
48088-4729
US

IV. Provider business mailing address

27427 SCHOENHERR RD SUITE 200
WARREN MI
48088-4729
US

V. Phone/Fax

Practice location:
  • Phone: 586-547-4417
  • Fax: 586-574-4473
Mailing address:
  • Phone: 586-547-4417
  • Fax: 586-574-4473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number4301066091
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301066091
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4876080001
License Number State

VIII. Authorized Official

Name: MS. JULIE L HENRY
Title or Position: OWNER
Credential: M.D.
Phone: 586-574-4417