MEDICARE: BORIS HAVKIN MD

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	208800000X	Urology Physician	ME90111	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01164118	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37966	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609867696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BORIS HAVKIN MD

Provider Business Mailing Address
First Line	:	3021 W EAU GALLIE BLVD STE 103
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32934-7005
Country	:	US
Telephone Number	:	321-500-4545
Fax Number	:	321-425-4000

Provider Business Practice Location Address
First Line	:	3021 W EAU GALLIE BLVD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32934-7005
Country	:	US
Telephone Number	:	321-500-4545
Fax Number	:	321-425-4000

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	06/05/2019

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