Individual
JOSEPH MARVIN HENDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1400 N RITTER AVE, STE 370, INDIANAPOLIS, IN 46219
(317) 355-1144
(317) 355-1155
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01042307A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000793527
ANTHEM
IN
05
—
100474160A
—
IN
01
—
P01170017
RR MEDICARE PTAN
IN
Enumeration date
03/03/2006
Last updated
11/27/2023
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