Most Relevant Information
Provider Data
| NPI Number: | 1003215047 |
| Provider Name: | DAVID HENRY |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 10001704A |
Most Important Dates
| Enumeration Date: | 08/15/2014 |
| Last Updated: | 09/24/2020 |
Provider Practice Location
509 N PERU ST
CICERO
IN
460349499
Practice Location Phone/Fax
| Phone: | 3179849311 |
| Fax: | 3179849302 |
Provider Mailing Location
PO BOX 775985
CHICAGO
IL
606775985
Provider Mailing Phone/Fax
| Phone: | 3177706900 |
| Fax: | 3177706911 |