Individual
BRYAN HENRIQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
849 KELLOGG AVE, JANESVILLE, WI 53546-2808
(608) 755-7964
Mailing address
849 KELLOGG AVE, JANESVILLE, WI 53546-2808
(608) 755-7964
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
101387-851
WI
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/04/2025
Last updated
05/30/2025
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