Healthcare Provider Details

I. General information

NPI: 1073716809
Provider Name (Legal Business Name): MARY KRISTINA HENZEL MD, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 EAST BLVD
CLEVELAND OH
44106-1702
US

IV. Provider business mailing address

10701 EAST BLVD LOUIS STOKES CLEVELAND VA MEDICAL CENTER, 128(W)
CLEVELAND OH
44106-1702
US

V. Phone/Fax

Practice location:
  • Phone: 216-791-3800
  • Fax: 216-707-5912
Mailing address:
  • Phone: 216-791-3800
  • Fax: 216-707-5912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberMD439178
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: