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NPI Code Detail

MEDICARE: BRANDON PSYCHIATRIC GROUP LLC

MEDICARE: BRANDON PSYCHIATRIC GROUP LLC
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
12084B0040XBehavioral Neurology & Neuropsychiatry Physician95351FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952710147
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRANDON PSYCHIATRIC GROUP LLC
Provider Business Mailing Address
First Line : PO BOX 1584
Second Line :
City : CUMMING
State : GA
Zip : 30028-1584
Country : US
Telephone Number : 678-923-6025
Fax Number : 813-413-6660
Provider Business Practice Location Address
First Line : 106 W WINDHORST RD
Second Line :
City : BRANDON
State : FL
Zip : 33510-2455
Country : US
Telephone Number : 678-923-6025
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. HANY BOTROS MIKHAIL
Credential : M.D.
Telephone Number : 678-923-6025
Provider Enumeration Date : 08/13/2014
Last Update Date : 02/06/2019

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