Provider Demographics
NPI:1801888250
Name:HENSLEY, MICHAEL FREDERICK (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:FREDERICK
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ASHLEY PL
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5322
Mailing Address - Country:US
Mailing Address - Phone:228-875-5571
Mailing Address - Fax:
Practice Address - Street 1:761 ESTERS BLVD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-3134
Practice Address - Country:US
Practice Address - Phone:228-435-3641
Practice Address - Fax:228-435-4853
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08138208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123688Medicaid
MS00123688Medicaid