Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH10214 | FL |
NPI | 1679878656 |
---|---|
Provider Name | Dr. Michael James Hennings |
First Address | Palm City, FL 34990-3720 |
Second Address | Palm City, FL 34990-3720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2011 |
Last Update Date | 29/08/2013 |