Individual
DR. MATTHEW EDWARD HENNIG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
207 SPARKS AVE STE 201, JEFFERSONVILLE, IN 47130-3739
(812) 280-1419
(812) 280-1451
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
01071815A
IN
208600000X
Surgery Physician
036126188
IL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
01071815A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01071815A
STATE LICENSE
IN
05
—
201189360
—
IN
05
—
7100452410
—
KY
Enumeration date
06/10/2008
Last updated
02/23/2024
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