MEDICARE: HENKIN NEUROSURGERY PA

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	174400000X	Specialist	ME75992	FL

General Provider Information

NPI Number	:	1295754422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENKIN NEUROSURGERY PA

Provider Business Mailing Address
First Line	:	1007 PROFESSIONAL PARK DR
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-4886
Country	:	US
Telephone Number	:	813-651-3300
Fax Number	:	813-651-4455

Provider Business Practice Location Address
First Line	:	1007 PROFESSIONAL PARK DR
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-4886
Country	:	US
Telephone Number	:	813-651-3300
Fax Number	:	813-651-4455

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHILIP HENKIN
Credential	:	M.D.
Telephone Number	:	813-651-3300

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	11/25/2008

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