Individual
DR. VINCENT CHARLES HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3575 PORTAGE RD, SOUTH BEND, IN 46628-6092
(574) 647-4530
(574) 647-4531
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01033656A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000085144
BCBS BMG MAIN ST
IN
01
—
000000085145
BCBS BMG MEDPOINT IRELAND
IN
01
—
000000319907
BCBS BMG PORTAGE RD
IN
01
—
000000588530
BCBS BMG E BLAIR WARNER
IN
01
—
080073934
RR MEDICARE
IN
05
—
200064640
—
IN
Enumeration date
10/11/2005
Last updated
03/17/2016
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