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Michael Medapally Henry

Pediatrics

Allopathic & Osteopathic Physicians

855 N Westhaven Dr, Oshkosh, WI 54904-7668

PECOS Enrollment

This provider is enrolled in PECOS as MICHAEL HENRY.

Based on the most recent information from CMS, provider Michael Medapally Henry is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1992060693
Provider Type
Individual
Full Name
Henry, Michael Medapally
Title
Dr.
Credential
MD

Gender
Male
Sole Proprietor
Yes
Enumeration Date
7/9/2012
Last Updated
8/4/2025

Contact Information

Practice Location

855 N Westhaven Dr, Oshkosh, WI 54904-7668

(920) 303-8700

(920) 456-7601

Mailing Location

PO Box 735044, Chicago, IL 60673-5044

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 2080N0001X Primary	Description Pediatrics Allopathic & Osteopathic Physicians	License 3011 Wisconsin
Code 2080N0001X	Description Pediatrics Allopathic & Osteopathic Physicians	License D84800 Maryland
Code 2080N0001X	Description Pediatrics Allopathic & Osteopathic Physicians	License C1-0027768 Delaware

Provider Identifiers

ID	Description	Issuer
ID 100236462	Description Medicaid	Issuer Unlisted Wisconsin

Michael Medapally Henry

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Liebeskind, Abraham Joseph

Hermes, Deborah M