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General NPI Number Information
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NPI Number | 1063489433
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Entity Type | Individual
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Provider Name | HENRY W. MAICKI M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/03/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 24353 ORCHARD LAKE RD SUITE E
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-1917
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Country | US
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Telephone | 248-471-4777
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Fax | 248-477-1613
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Provider Business Mailing Address
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Address Line | 24353 ORCHARD LAKE RD SUITE E
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-1917
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Country | US
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Telephone | 248-471-4777
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Fax | 248-477-1613
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | HM026513
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License Number State | MI
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