Dr Henderson Judy MD Family Medicine PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

4301088108 Issued in MI

Legal business name

DR HENDERSON JUDY MD FAMILY MEDICINE PLLC

Practice address

24 N Saint Joseph Ave
Suite C 2
Niles, MI 49120-2263

Phone

(269) 683-0330

Fax

(269) 684-0400

NPI assigned

Jan 24, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Judy D. Henderson, MD

Title

Owner

Phone

(269) 683-0330

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1485216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485648000000",
    "number": "1841737277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 N SAINT JOSEPH AVE",
            "address_2": "SUITE C 2",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202263",
            "telephone_number": "269-683-0330",
            "fax_number": "269-684-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 N SAINT JOSEPH AVE",
            "address_2": "SUITE C 2",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202263",
            "telephone_number": "269-683-0330",
            "fax_number": "269-684-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR HENDERSON JUDY MD FAMILY MEDICINE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-24",
        "last_updated": "2017-01-29",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-683-0330",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301088108",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1101111081",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1700813227",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0111108",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heaven Dokey
• Roberta Lynn Doll
• Gabriela Karla Dormus Parra
• Douglas Tacket DO PLLC
• Sarah Michelle Dowell, P.A. ASCP
• John R Dronen I, PT
• Gary Otis Duffield Jr., D.C., C.AD.
• Moriah Irene Duncan, LLMSW
• Faith Dykla
• Ashley L Dziubinski, MOTR

• Internal Medicine Physician in Niles, MI
• Providers in Niles, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2017; 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.