Provider Demographics
NPI:1174373013
Name:HENKE, MARTIN L II
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:L
Last Name:HENKE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 E MAIN ST APT B5
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-3845
Mailing Address - Country:US
Mailing Address - Phone:170-140-0234
Mailing Address - Fax:
Practice Address - Street 1:1706 E MAIN ST APT B5
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-3845
Practice Address - Country:US
Practice Address - Phone:170-140-0234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care