Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 00014952 | AL |
N | 207RE0101X | Endocrinologist (Diabetes Doctor) | 173573 | AK |
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | ME133406 | FL |
NPI | 1003971839 |
---|---|
Provider Name | Dr. Michael A. Hennigan |
First Address | Gulf Breeze, FL 32561-4380 |
Second Address | Gulf Breeze, FL 32561-4380 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 11/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000081181 | (05) | AL |
000081181 | BCBS OF AL PROVIDER NUMBE (01) | AL |
022091600 | (05) | FL |
529910470 | (05) | AL |
C84459 | (02) | AL |