MEDICARE: DR. ENRIQUE HANABERGH 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	207RC0000X	Cardiovascular Disease Physician	ME0031803	FL

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	:	1821087156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ENRIQUE HANABERGH M.D.

Provider Business Mailing Address
First Line	:	21110 BISCAYNE BLVD
Second Line	:	SUITE #206
City	:	AVENTURA
State	:	FL
Zip	:	33180-1227
Country	:	US
Telephone Number	:	305-933-2111
Fax Number	:	305-933-3203

Provider Business Practice Location Address
First Line	:	21110 BISCAYNE BLVD
Second Line	:	SUITE #206
City	:	AVENTURA
State	:	FL
Zip	:	33180-1227
Country	:	US
Telephone Number	:	305-933-2111
Fax Number	:	305-933-3203

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	05/26/2010

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