Provider Demographics
NPI:1063489433
Name:MAICKI, HENRY W (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:W
Last Name:MAICKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:24353 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1917
Mailing Address - Country:US
Mailing Address - Phone:248-471-4777
Mailing Address - Fax:248-477-1613
Practice Address - Street 1:24353 ORCHARD LAKE RD
Practice Address - Street 2:SUITE E
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1917
Practice Address - Country:US
Practice Address - Phone:248-471-4777
Practice Address - Fax:248-477-1613
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIHM026513207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0632414OtherBLUE CROSS BLUE SHIELD
148134OtherGREAT LAKES HEALTH PLAN
MI102619OtherCARE CHOICES HMO
4398521OtherAETNA
MI0632414OtherBLUE CARE NETWORK
MIC4990OtherM CARE
MI102619OtherPREFERRED CHOICES PPO
MI4359002Medicaid
B44102Medicare UPIN
MIC4990OtherM CARE