Individual
MALIK HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
N91W16112 JUNCTION WAY APT 304, MENOMONEE FALLS, WI 53051-3195
(414) 795-4551
Mailing address
N91W16112 JUNCTION WAY APT 304, MENOMONEE FALLS, WI 53051-3195
(414) 795-4551
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100139027
—
WI
Enumeration date
12/07/2020
Last updated
12/07/2020
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