# KAROL J HENDRICKSON DO PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922236942
- **Authorized official:** MS. CYNTHIA R MOORE (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (734) 207-5226

## Contact information

- **Practice address:** 4669 12TH RD, ESCANABA, MI 49829-9605
- **Practice address phone:** (906) 786-9391
- **Mailing address:** 4669 12TH RD, ESCANABA, MI 49829-9605
- **Mailing address phone:** (906) 786-9391

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | 5101012173 | MI | Yes |

## Other

- **Enumeration date:** 06/29/2009
- **Last updated:** 07/30/2009