Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 201400774 | NC |
NPI | 1003137407 |
---|---|
Provider Name | Dr. Kamal Hanee Henderson |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Aurora, CO 80045-7211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2010 |
Last Update Date | 24/12/2021 |