Organization Name: | AMY HALLAL HENDERSON MD LLC |
NPI Number: | 1528459278 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AMY HALLAL HENDERSON (PHYSICIAN) |
Mailing Address: | 2 Silvercrest Dr Suite 100 New Albany |
State: | IN US |
Postal Code: | 471507800 |
Phone Number: | 8129481641 |
Fax Number: | |
NPI Enumeration Date: | 02/16/2015 |
NPI Last Update Date: | 02/16/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 01052944A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |