MEDICARE: MADELINE HENRY

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	247200000X	Other Technician

General Provider Information

NPI Number	:	1801318910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE HENRY

Provider Business Mailing Address
First Line	:	7504 CUTLASS AVE
Second Line	:
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-4114
Country	:	US
Telephone Number	:	786-308-7955
Fax Number	:

Provider Business Practice Location Address
First Line	:	419 W 49TH ST STE 210
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3657
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

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

Provider Enumeration Date	:	07/10/2017
Last Update Date	:	07/10/2017

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Directions to “ MADELINE HENRY ” Practice Location

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