MEDICARE: HENKIN NEUROSURGERY P A

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	207T00000X	Neurological Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730369729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENKIN NEUROSURGERY P A

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/OWNER
Name	:	PHILIP HENKIN
Credential	:	M.D.
Telephone Number	:	813-651-3300

Provider Enumeration Date	:	11/07/2007
Last Update Date	:	12/03/2008

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