Individual
CODY HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2587 DORCHESTER RD, BIRMINGHAM, MI 48009-7410
(248) 790-0908
Mailing address
305 S STATE ST, ABERDEEN, SD 57401-4527
(605) 622-5000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
5101025652
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/16/2019
Last updated
07/12/2022
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