MEDICARE: DR. ROBERT E HENDRICKS DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OH2094	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245204817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT E HENDRICKS DO

Provider Business Mailing Address
First Line	:	10251 MAIN ST
Second Line	:
City	:	NEW MIDDLETOWN
State	:	OH
Zip	:	44442-9717
Country	:	US
Telephone Number	:	330-542-2315
Fax Number	:	330-542-9700

Provider Business Practice Location Address
First Line	:	10251 MAIN ST
Second Line	:
City	:	NEW MIDDLETOWN
State	:	OH
Zip	:	44442-9717
Country	:	US
Telephone Number	:	330-542-2315
Fax Number	:	330-542-9700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	07/08/2007

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