MEDICARE: MR. MICHAEL CHRISTOPHER HENRY IDHS

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	171000000X	Military Health Care Provider
2	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1336124262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL CHRISTOPHER HENRY IDHS

Provider Business Mailing Address
First Line	:	2703 MARTIN LUTHER KING JR AVE SE STOP 7201
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20593-7201
Country	:	US
Telephone Number	:	202-372-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2703 MARTIN LUTHER KING JR AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20593-0001
Country	:	US
Telephone Number	:	202-372-4100
Fax Number	:

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	05/29/2025

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