Healthcare Provider Details

I. General information

NPI: 1588666838
Provider Name (Legal Business Name): JAMES ROBERT HENNESSY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 CHERRY ST STE 2800
TOLEDO OH
43608-2675
US

IV. Provider business mailing address

BOX 472
MONROE MI
48161-4022
US

V. Phone/Fax

Practice location:
  • Phone: 419-936-6929
  • Fax: 419-251-7761
Mailing address:
  • Phone: 419-936-6929
  • Fax: 419-251-7761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number35043054
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: