Provider Demographics
NPI:1962683292
Name:HENDRICKSON, BENCY
Entity type:Individual
Prefix:DR
First Name:BENCY
Middle Name:
Last Name:HENDRICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4328 PAGE AVE
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49254-1077
Mailing Address - Country:US
Mailing Address - Phone:517-764-3609
Mailing Address - Fax:517-764-3669
Practice Address - Street 1:4328 PAGE AVE
Practice Address - Street 2:
Practice Address - City:MICHIGAN CENTER
Practice Address - State:MI
Practice Address - Zip Code:49254-1077
Practice Address - Country:US
Practice Address - Phone:517-764-3609
Practice Address - Fax:517-764-3669
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine