MEDICARE: DR. MICHAEL HERSHORN PHD

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	103TC0700X	Clinical Psychologist	PY0003824	FL

General Provider Information

NPI Number	:	1588655864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL HERSHORN PHD

Provider Business Mailing Address
First Line	:	PO BOX 9318
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33075-9318
Country	:	US
Telephone Number	:	954-614-2326
Fax Number	:	954-752-5246

Provider Business Practice Location Address
First Line	:	7301 N UNIVERSITY DR
Second Line	:	SUITE 209
City	:	TAMARAC
State	:	FL
Zip	:	33321-2919
Country	:	US
Telephone Number	:	954-614-2326
Fax Number	:	954-752-5246

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	07/08/2007

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