Doctor Name: | DR. JON R HENKE |
NPI Number: | 1003838418 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 4301045317 |
Business Practice Address: | 3264 N Evergreen Dr Ne Grand Rapids, MI - 495259746 |
Business Phone Number: | 6163637272 |
Business Fax Number: | 6163637290 |
Mailing Address: | 3264 N Evergreen Dr Ne, GRAND RAPIDS |
State: | MI |
Postal Code: | 495259746 |
Phone Number: | 6163637272 |
Fax Number: | 6163637290 |
NPI Enumeration Date: | 07/24/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2085R0202X |
License Number: | 4301045317 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Radiology |
Taxonomy Specialization: | Diagnostic Radiology |
Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |