Individual
ANDREW H. HENDERSON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-4530
(859) 258-4870
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-4530
(859) 258-4870
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19017
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110055349
RR MEDICARE PIN
GA
01
—
37903705
MEDICAID LAB GRP
KY
01
—
4000501
MEDICARE LAB GRP
KY
05
—
64190176
—
KY
01
—
CB5773
RR MEDICARE GRP
GA
Enumeration date
07/12/2006
Last updated
03/01/2021
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