Basic Information
| Provider Information | |||||||||
| NPI: | 1316181555 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HENNING MEHRENS, MD, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2130 LAKE TAHOE BLVD | ||||||||
| Address2: | |||||||||
| City: | SOUTH LAKE TAHOE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961506405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305413277 | ||||||||
| FaxNumber: | 5305416913 | ||||||||
| Practice Location | |||||||||
| Address1: | 2130 LAKE TAHOE BLVD | ||||||||
| Address2: | |||||||||
| City: | SOUTH LAKE TAHOE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 961506405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305413277 | ||||||||
| FaxNumber: | 5305416913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2009 | ||||||||
| LastUpdateDate: | 10/22/2014 | ||||||||
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| AuthorizedOfficialLastName: | MEHRENS | ||||||||
| AuthorizedOfficialFirstName: | HENNING | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5305413277 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.