Individual
DR. SEAN MATTHEW HENNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
2310 CALIFORNIA RD, ELKHART, IN 46514-1228
(574) 264-0791
(574) 262-5183
Mailing address
2310 CALIFORNIA RD, ELKHART, IN 46514-1228
(574) 264-0791
(574) 262-9650
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000915A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200450180
—
IN
01
—
480031993
PALMETTO GBA-RAILROAD MEDICARE
IN
Enumeration date
07/24/2006
Last updated
02/02/2010
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