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Individual
DR. SUSAN K HENRY
Active
Individual
DR. SUSAN K HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301042734
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0530023
BLUE CROSS BLUE SHIELD
MI
01
—
383322171
TAX ID
MI
05
—
4375777
—
MI
01
—
CJ9804
RAILROAD MEDICARE GBA PIN
MI
Enumeration date
06/02/2006
Last updated
04/01/2016
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