Individual
DAVID EUGENE HENDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1 CARPET ALLEY, MADISON, IN 47250
(812) 265-2011
(812) 273-1769
Mailing address
1 CARPET ALY, MADISON, IN 47250-3562
(812) 265-2011
(812) 273-1769
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000436A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000087922
ANTHEM BCBS
—
05
—
100148890A
—
IN
01
—
257980A
MEDICARE DME
IN
01
—
35-1787467
TAX ID
—
01
—
411730
MEDICARE DME
IN
Enumeration date
07/08/2005
Last updated
06/27/2024
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