MEDICARE: MICHELLE HENNE, M.D., 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	261QM2500X	Medical Specialty Clinic/Center	ME121120	FL
2	207QS0010X	Sports Medicine (Family Medicine) 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	:	1962938894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELLE HENNE, M.D., P.A.

Provider Business Mailing Address
First Line	:	5535 CYPRESS GARDENS BLVD STE 270
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-2241
Country	:	US
Telephone Number	:	863-401-4401
Fax Number	:	863-410-1108

Provider Business Practice Location Address
First Line	:	5535 CYPRESS GARDENS BLVD STE 270
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-2241
Country	:	US
Telephone Number	:	863-401-4401
Fax Number	:	863-410-1108

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHELLE HENNE
Credential	:	M.D.
Telephone Number	:	863-401-4401

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	08/20/2025

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