MEDICARE: IHAB HERRAKA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	TRN10010	FL
2	207RG0100X	Gastroenterology Physician	E-7210	AR
3	207RG0100X	Gastroenterology Physician	31083	OK
4	207RG0100X	Gastroenterology Physician	E7210	AR
5	207RG0100X	Gastroenterology Physician	ME111070	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174610018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IHAB HERRAKA M.D.

Provider Business Mailing Address
First Line	:	14690 SPRING HILL DR
Second Line	:	STE 305
City	:	SPRING HILL
State	:	FL
Zip	:	34609-8102
Country	:	US
Telephone Number	:	352-277-5348
Fax Number	:	352-606-2857

Provider Business Practice Location Address
First Line	:	5196 MARINER BLVD
Second Line	:
City	:	SPRING HILL
State	:	FL
Zip	:	34609-1802
Country	:	US
Telephone Number	:	352-263-2831
Fax Number	:	352-263-2845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	11/27/2020

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Directions to “ IHAB HERRAKA M.D.” Practice Location

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