Healthcare Provider Details

I. General information

NPI: 1407328693
Provider Name (Legal Business Name): HANCEAU DORVIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HANCEAU DORVIL DR HANCEAU DORVIL MD

II. Dates (important events)

Enumeration Date: 12/28/2018
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5190 NW 167TH ST STE 109
MIAMI LAKES FL
33014-6329
US

IV. Provider business mailing address

8333 NW 53RD ST FL 6
DORAL FL
33166-4783
US

V. Phone/Fax

Practice location:
  • Phone: 305-851-2860
  • Fax: 866-539-7038
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9295958
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN1655
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: