Provider Demographics
NPI:1033902820
Name:HENDERSON, MARCUS JAMES I
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:JAMES
Last Name:HENDERSON
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4166 OKALONA RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-3165
Mailing Address - Country:US
Mailing Address - Phone:216-867-8504
Mailing Address - Fax:
Practice Address - Street 1:4166 OKALONA RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-3165
Practice Address - Country:US
Practice Address - Phone:216-867-8504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-26
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty