Individual
CLIFFORD DANIEL HENDRICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 UNIVERSITY PKWY, HIGH POINT, NC 27268-1050
(336) 841-4683
(336) 888-6353
Mailing address
1500 EASTWAY DRIVE, KENT, OH 44242-0001
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2016-02115
NC
207R00000X
Internal Medicine Physician
Primary
35.143460
OH
207R00000X
Internal Medicine Physician
4301071675
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1108124371
BCBS
MI
01
—
700H110750
BCBS
MI
01
—
C5702
MCARE
MI
Enumeration date
08/31/2006
Last updated
10/11/2022
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