MEDICARE: MICHAEL N HENEIN MD PC

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	363LF0000X	Family Nurse Practitioner	4704190384	MI

General Provider Information

NPI Number	:	1790927234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL N HENEIN MD PC

Provider Business Mailing Address
First Line	:	62550 MORNINGSIDE DR
Second Line	:
City	:	WASHINGTON TWP
State	:	MI
Zip	:	48094-1325
Country	:	US
Telephone Number	:	313-885-8589
Fax Number	:

Provider Business Practice Location Address
First Line	:	75 BARCLAY CIR STE 118
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-5803
Country	:	US
Telephone Number	:	248-312-9300
Fax Number	:

Authorized Official
Title or Position	:	NP-C
Name	:	MRS. KATHLEEN ANN HENEIN
Credential	:
Telephone Number	:	313-885-8589

Provider Enumeration Date	:	03/30/2009
Last Update Date	:	04/10/2019

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