Individual
DR. BRUCE T HENDERSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
44555 WOODWARD AVE, SUITE 407, PONTIAC, MI 48341-5031
(248) 334-0524
(248) 858-3887
Mailing address
44555 WOODWARD AVE, SUITE 407, PONTIAC, MI 48341-5031
(248) 334-0524
(248) 858-3887
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
039951
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0638406
BLUE CROSS/BLUE SHIELD
MI
05
—
4513265
—
MI
Enumeration date
03/17/2006
Last updated
07/08/2007
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