Individual
MARK R HENDRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3100 SUPERIOR AVE, SHEBOYGAN, WI 53081-1948
(920) 496-4700
Mailing address
3100 SUPERIOR AVE, SHEBOYGAN, WI 53081-1948
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
24824
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31417300
—
WI
Enumeration date
06/14/2006
Last updated
01/15/2010
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