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NPI Code Detail

MEDICARE: LYDIA JEANNETTE HENDERSON

MEDICARE: LYDIA JEANNETTE HENDERSON
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
1208100000XPhysical Medicine & Rehabilitation Physician125.081124IL
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1942835053
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYDIA JEANNETTE HENDERSON
Provider Business Mailing Address
First Line : 355 E ERIE ST
Second Line :
City : CHICAGO
State : IL
Zip : 60611-3167
Country : US
Telephone Number : 312-238-1000
Fax Number :
Provider Business Practice Location Address
First Line : 251 E HURON ST
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2908
Country : US
Telephone Number : 312-238-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2020
Last Update Date : 12/26/2025

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Directions to “ LYDIA JEANNETTE HENDERSON ” Practice Location

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