Organization
MARLENE K HENZE MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARLENE K HENZE MD (PRESIDENT)
(815) 416-1331
Entity
Organization
Contact information
Practice address
151 W HIGH ST, MORRIS, IL 60450-1407
(815) 416-1331
(815) 634-3188
Mailing address
35 E WILLOW ST STE B, COAL CITY, IL 60416-1869
(815) 634-3048
(815) 634-3188
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
036093007
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036093007
ILLINOIS MEDICAID
—
01
—
080181425
MEDICARE RAILROAD
IL
01
—
3227787
BCBS OF IL
IL
Enumeration date
07/26/2010
Last updated
09/20/2011
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