Provider Demographics
NPI:1285995811
Name:HENKE, STEPHEN GERARD (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GERARD
Last Name:HENKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1304 S COLLEGE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4114
Mailing Address - Country:US
Mailing Address - Phone:970-482-0549
Mailing Address - Fax:970-493-1192
Practice Address - Street 1:1304 S COLLEGE AVE STE 5
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4114
Practice Address - Country:US
Practice Address - Phone:970-482-0549
Practice Address - Fax:970-493-1192
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO51150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine