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Contact Information

ANDREW A HENNEBERG, MD
980 W IRONWOOD DR
SUITE 201
COEUR D'ALENE, ID83814
 Phone: 208-765-4888
 Fax: 208-667-8618
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Obstetrics & Gynecology

207V00000X 16 Physician/Obstetrics & Gynecology
 

Specialist

174400000X
Indicates primary specialty

NPI Profile & details for ANDREW A HENNEBERG · (Male)

NPI # 1689603847
Status Active
Credentials MD
Entity Individual
Enumeration date 07/01/2006
Last updated 05/14/2020 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • ID License # M-9485
  • ID Medicaid 807438700
Hospital affiliation(s)
  • KOOTENAI MEDICAL CENTER - (Acute Care)
    2003 KOOTENAI HEALTH WAY
    COEUR D'ALENE, ID 83814
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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