Organization
DR HENDERSON JUDY MD FAMILY MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUDY D. HENDERSON MD (OWNER)
(269) 683-0330
Entity
Organization
Contact information
Practice address
24 N SAINT JOSEPH AVE, SUITE C 2, NILES, MI 49120-2263
(269) 683-0330
(269) 684-0400
Mailing address
24 N SAINT JOSEPH AVE, SUITE C 2, NILES, MI 49120-2263
(269) 683-0330
(269) 684-0400
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301088108
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0111108
BCBS
—
01
—
1101111081
BLUE CROSS BLUE SHIELD
MI
05
—
1700813227
—
MI
Enumeration date
01/24/2017
Last updated
01/29/2017
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