Healthcare Provider Details

I. General information

NPI: 1427040906
Provider Name (Legal Business Name): MICHAEL W HENNIGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1847 FLORIDA AVE
PANAMA CITY FL
32405-4640
US

IV. Provider business mailing address

1847 FLORIDA AVE
PANAMA CITY FL
32405-4640
US

V. Phone/Fax

Practice location:
  • Phone: 850-914-8660
  • Fax: 850-914-6036
Mailing address:
  • Phone: 850-914-8660
  • Fax: 850-914-6036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberME0064533
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: