Individual
DAVID HENRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1160 S PERU ST, CICERO, IN 46034-9601
(317) 984-9311
(317) 984-9302
Mailing address
PO BOX 843022, KANSAS CITY, MO 64184-3022
(317) 770-6900
(317) 770-6911
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001704A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
241888770
—
IN
Enumeration date
08/15/2014
Last updated
09/12/2025
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