Provider Demographics
NPI:1144484924
Name:HENDERSON, HEATHER LYNN (DO)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:45640 SCHOENHERR RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-6033
Mailing Address - Country:US
Mailing Address - Phone:586-247-4300
Mailing Address - Fax:586-532-6496
Practice Address - Street 1:18001 E 10 MILE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-3803
Practice Address - Country:US
Practice Address - Phone:586-218-5800
Practice Address - Fax:586-218-5808
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2016-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101017819207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H26358Medicare PIN