Individual provider Active NPI

William E Henry, MD

  • Diagnostic Radiology Physician
  • Petoskey, MI
National Provider Identifier
1205835824
Registry record updated Aug 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
4301079440 Issued in MI
Practice address
416 Connable Ave
Petoskey, MI 49770-2212
Phone
(231) 487-4000
NPI assigned
Jul 15, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 4301079440 MI Primary

Addresses

Primary practice location

416 Connable Ave
Petoskey, MI 49770-2212

Mailing address

416 Connable Ave
Petoskey, MI 49770-2297
Phone (989) 401-4245

Other identifiers 3

IdentifierTypeStateIssuer
3102401362OtherMIBCBS
300133326OtherMIRAILROAD MEDICARE
104403951MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534204800000",
    "number": "1205835824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 CONNABLE AVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702297",
            "telephone_number": "989-401-4245",
            "fax_number": "989-401-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 CONNABLE AVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702212",
            "telephone_number": "231-487-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "WILLIAM",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-15",
        "last_updated": "2018-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301079440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "3102401362",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300133326",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104403951",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2018; 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.