Provider Demographics
NPI:1447439294
Name:KMAK HENDRIX & MCNEELEY PLLC
Entity type:Organization
Organization Name:KMAK HENDRIX & MCNEELEY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-720-5715
Mailing Address - Street 1:7148 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0071
Mailing Address - Country:US
Mailing Address - Phone:810-720-5715
Mailing Address - Fax:810-600-1597
Practice Address - Street 1:4201 SAINT ANTOINE ST
Practice Address - Street 2:UNIVERSITY HEALTH CENTER, 4F
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2153
Practice Address - Country:US
Practice Address - Phone:313-745-0499
Practice Address - Fax:810-833-8801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty