Organization
C.A. HENDRICKS M.D. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLIFFORD HENDRICKS M.D. (DOCTOR)
(319) 362-9855
Entity
Organization
Contact information
Practice address
1136 H AVE NE, CEDAR RAPIDS, IA 52402-4624
(319) 362-9855
(319) 362-0655
Mailing address
1136 H AVE NE, CEDAR RAPIDS, IA 52402-4624
(319) 362-9855
(319) 362-0655
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
Primary
15724
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0029744
—
IA
01
—
02974
BCBS
IA
01
—
181765472
RR MEDICARE
—
01
—
4501
MIDLANDS
IA
Enumeration date
09/09/2008
Last updated
09/09/2008
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