Individual
JERALD W HENRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
468 CADIEUX ROAD, GROSSE POINTE, MI 48230
(313) 343-1630
(313) 343-1665
Mailing address
PO BOX 1108, ATTN:BARB SIMMONS, ANN ARBOR, MI 48106-1108
(313) 343-1630
(313) 343-1665
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
4301072837
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
310H249790
BCBS GROUP PIN
MI
05
—
4536143
—
MI
01
—
CB6220
MEDICARE RR GROUP PIN
MI
01
—
P00063375
MEDICARE RR IND PIN
MI
Enumeration date
05/03/2006
Last updated
10/31/2022
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