David R Hendricks, M.D.

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

License

4301038246 Issued in MI

Practice address

153 1/2 E Front St
Traverse City, MI 49684-5729

Phone

(231) 941-6670

Fax

(231) 941-6675

NPI assigned

Jan 9, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629763200000",
    "number": "1013066406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12100 S BENZONIA TRL",
            "address_2": "SUITE D",
            "city": "EMPIRE",
            "state": "MI",
            "postal_code": "496308503",
            "telephone_number": "231-326-3002",
            "fax_number": "231-326-3026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 1/2 E FRONT ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496845729",
            "telephone_number": "231-941-6670",
            "fax_number": "231-941-6675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKS",
        "first_name": "DAVID",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "MI",
            "license": "4301038246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4858998",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "11-0-28-1081-1",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Hemming-McKolay
• Mark Travis Hemming, M.D.
• Glen H Henbest, DO
• Jennifer Leigh Henbest, O.D.
• Susan K Henderson
• James S Hendricks
• Derek Hendrickson, PA-C
• Emily Hendry
• Terese Marie Henley, LMSW
• Aimee Hennessy

• Addiction Medicine (Internal Medicine) Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Addiction Medicine (Internal Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.