MEDICARE: MS. SUSAN COLLEEN HENDRICKSON 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
1	208000000X	Pediatrics Physician	4301060917	MI

Other Identifiers

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

General Provider Information

NPI Number	:	1902901366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN COLLEEN HENDRICKSON MD

Provider Business Mailing Address
First Line	:	PO BOX 2201
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48707-2201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 WASHINGTON AVE
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48707-9801
Country	:	US
Telephone Number	:	989-667-6977
Fax Number	:

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	02/02/2016

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