MEDICARE: MICHAEL K. HERRON M. D.

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	2085R0202X	Diagnostic Radiology Physician	MD.11684R	LA
2	2085R0202X	Diagnostic Radiology Physician	ME84779	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00060963	OTHER	FL	RR MEDICARE
3	P00352559	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	81554	OTHER	FL	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700867207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL K. HERRON M. D.

Provider Business Mailing Address
First Line	:	8303 S SUNCOAST BLVD
Second Line	:
City	:	HOMOSASSA
State	:	FL
Zip	:	34446-5028
Country	:	US
Telephone Number	:	352-688-8200
Fax Number	:

Provider Business Practice Location Address
First Line	:	8303 S SUNCOAST BLVD
Second Line	:
City	:	HOMOSASSA
State	:	FL
Zip	:	34446-5028
Country	:	US
Telephone Number	:	352-688-8200
Fax Number	:

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	09/14/2020

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