Individual
MICHAEL P HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
16533 N STATE HIGHWAY 5 STE 201, SUNRISE BEACH, MO 65079-6769
(573) 374-4600
(573) 374-4608
Mailing address
16533 N STATE HIGHWAY 5 STE 201, SUNRISE BEACH, MO 65079-6769
(573) 374-4600
(573) 374-4608
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
106206
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
247988462
—
MO
01
—
P01155055
RAIL ROAD MEDICARE
—
Enumeration date
06/20/2006
Last updated
03/16/2014
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