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NPI Code Detail

MEDICARE: ROY HENDERSON MD

MEDICARE: ROY 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 Physician036-104711IL
2207Q00000XFamily Medicine Physician01075456AIN
3207QS0010XSports Medicine (Family Medicine) Physician036104711IL
4207QS0010XSports Medicine (Family Medicine) Physician01075456AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1861426694
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROY HENDERSON MD
Provider Business Mailing Address
First Line : PO BOX 869
Second Line :
City : NOBLESVILLE
State : IN
Zip : 46061-0869
Country : US
Telephone Number : 317-770-6900
Fax Number : 317-770-6911
Provider Business Practice Location Address
First Line : 14535A HAZEL DELL PKWY
Second Line :
City : CARMEL
State : IN
Zip : 46033-9401
Country : US
Telephone Number : 317-705-4360
Fax Number : 317-705-4361
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 07/21/2022

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Directions to “ ROY HENDERSON MD” Practice Location

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