Healthcare Provider Details

I. General information

NPI: 1124029616
Provider Name (Legal Business Name): MICHAEL J HENNESSY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 16TH AVE S
GREAT FALLS MT
59405
US

IV. Provider business mailing address

1400 29TH ST S
GREAT FALLS MT
59405-5353
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-2171
  • Fax: 406-771-3021
Mailing address:
  • Phone: 406-454-2171
  • Fax: 406-771-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number7944
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: