Individual
DR. ALBERTA LEE HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
714 N MICHIGAN ST, SOUTH BEND, IN 46601-1035
(574) 284-7477
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-1070
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01043140A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200109040
—
IN
Enumeration date
10/11/2005
Last updated
05/01/2023
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