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NPI Code Detail

MEDICARE: TERRY LYNN HENDERSON MD

MEDICARE: TERRY LYNN HENDERSON MD
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
1207Q00000XFamily Medicine Physician01024494IN

Other Identifiers

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

General Provider Information

NPI Number : 1700884806
Entity Type Code : Individual
Provider Name (Legal Business Name) : TERRY LYNN HENDERSON MD
Provider Business Mailing Address
First Line : 8414 NAAB RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-1972
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8414 NAAB RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-1972
Country : US
Telephone Number : 317-338-7510
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 06/29/2022

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