Individual
CHARLES EDWARD HENLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1011 MAIN ST, INDIANAPOLIS, IN 46224-6977
(317) 957-9050
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
3508
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100031740D
—
OK
01
—
P01588239
RAILROAD PTAN
IN
Enumeration date
02/03/2006
Last updated
03/14/2016
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