Dr Robert A Henry Jr, DO | |
2817 New Pinery Road, Portage, WI 53901-9257 | |
(608) 742-4131 | |
Not Available |
Full Name | Dr Robert A Henry Jr |
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Gender | Male |
Speciality | Family Medicine |
Location | 2817 New Pinery Road, Portage, Wisconsin |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1740240308 | NPI | - | NPPES |
807629 | Other | TX | BLUE SHIELD |
1010845-02 | Medicaid | TX | |
080161793 | Other | TX | RR/MEDICARE |
1010845-01 | Other | TX | CSHCN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | H1102 (Texas) | Secondary |
207Q00000X | Family Medicine | 65243-21 (Wisconsin) | Primary |
Entity Name | Divine Savior Healthcare Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1124083894 PECOS PAC ID: 5799684007 Enrollment ID: O20040225000909 |
Mailing Address | Practice Location Address |
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Dr Robert A Henry Jr, DO 2817 New Pinery Road, Portage, WI 53901-9257 Ph: (608) 742-4131 | Dr Robert A Henry Jr, DO 2817 New Pinery Road, Portage, WI 53901-9257 Ph: (608) 742-4131 |
Kelly Coker, DO Family Medicine Medicare: Medicare Enrolled Practice Location: 2817 New Pinery Rd, Portage, WI 53901 Phone: 608-745-5145 | |
Richard J Qualy, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 2977 County Hwy Cx, Portage, WI 53901 Phone: 608-742-3004 Fax: 608-742-2399 | |
Gerald L Krumpos, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2825 Hunters Trl, Portage, WI 53901 Phone: 608-742-7161 Fax: 608-745-3060 | |
Dr. Jamie John Kling, DO Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2977 County Hwy Cx, Portage, WI 53901 Phone: 608-742-3004 Fax: 608-742-2399 | |
Dr. Sarah M Haroldson, MD Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2825 Hunters Trl, Portage, WI 53901 Phone: 608-742-7161 Fax: 608-745-3990 | |
Dr. Vasilisa Mironovich, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 2817 New Pinery Rd, Portage, WI 53901 Phone: 608-742-4131 Fax: 608-745-6393 | |
David D Gregory, MD Family Medicine Medicare: Not Enrolled in Medicare Practice Location: 2825 Hunters Trl, Portage, WI 53901 Phone: 608-724-7161 Fax: 608-745-3060 |