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NPI Code Detail

MEDICARE: MS. KAROL J HENDRICKSON DO

MEDICARE: MS. KAROL J HENDRICKSON DO
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 Physician5101012173MI

General Provider Information

NPI Number : 1902890940
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KAROL J HENDRICKSON DO
Provider Business Mailing Address
First Line : 325 E H ST
Second Line :
City : IRON MOUNTAIN
State : MI
Zip : 49801-4760
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 325 E H ST
Second Line :
City : IRON MOUNTAIN
State : MI
Zip : 49801-4760
Country : US
Telephone Number : 906-774-3300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2005
Last Update Date : 03/01/2019

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