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General NPI Number Information
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NPI Number | 1730907163
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Entity Type | Individual
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Provider Name | MICHAEL H HENDERSON
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Gender | Male
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 2448 S 102ND ST STE 180
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City | WEST ALLIS
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State | WI
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Zip | 53227-2150
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Country | US
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Telephone | 630-974-6602
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Fax | 630-487-2411
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Provider Business Mailing Address
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Address Line | 1100 JORIE BLVD STE 300
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City | OAK BROOK
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State | IL
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Zip | 60523-2219
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Country | US
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Telephone | 630-974-6602
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Fax | 630-487-2411
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 15997-33
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License Number State | WI
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