MEDICARE: MICHAEL J HENDRICKSON

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	372500000X	Chore Provider

General Provider Information

NPI Number	:	1457187692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J HENDRICKSON

Provider Business Mailing Address
First Line	:	68 VIRGINIA ST
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48342-1374
Country	:	US
Telephone Number	:	248-202-5378
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 VIRGINIA ST
Second Line	:
City	:	PONTIAC
State	:	MI
Zip	:	48342-1374
Country	:	US
Telephone Number	:	248-202-5378
Fax Number	:

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

Provider Enumeration Date	:	09/13/2024
Last Update Date	:	09/13/2024

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Directions to “ MICHAEL J HENDRICKSON ” Practice Location

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