Provider Demographics
NPI:1487883831
Name:HENDRICKS, GINNY L (MD)
Entity type:Individual
Prefix:
First Name:GINNY
Middle Name:L
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GINNY
Other - Middle Name:L
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2850 W 95TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2735
Mailing Address - Country:US
Mailing Address - Phone:708-425-9550
Mailing Address - Fax:708-229-6084
Practice Address - Street 1:2850 W 95TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2735
Practice Address - Country:US
Practice Address - Phone:708-425-9550
Practice Address - Fax:708-229-6084
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11015167A207Q00000X
IL036.129996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine