Basic Information
Provider Information
NPI: 1366635807
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HENSKE
FirstName: JOSEPH
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4301 W MARKHAM ST # 783
Address2:  
City: LITTLE ROCK
State: AR
PostalCode: 722057101
CountryCode: US
TelephoneNumber: 5016868000
FaxNumber: 5015265148
Practice Location
Address1: 4301 W MARKHAM ST # 587
Address2:  
City: LITTLE ROCK
State: AR
PostalCode: 722057101
CountryCode: US
TelephoneNumber: 5016865130
FaxNumber: 5012961224
Other Information
ProviderEnumerationDate: 08/18/2007
LastUpdateDate: 07/14/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/14/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101X036125983ILN Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
207RE0101XE-12377ARY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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