Provider Demographics
NPI:1225564073
Name:MICHELLE HENNE, M.D., P.A.
Entity Type:Organization
Organization Name:MICHELLE HENNE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-759-2562
Mailing Address - Street 1:1201 N SCENIC HWY
Mailing Address - Street 2:
Mailing Address - City:BABSON PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33827-9751
Mailing Address - Country:US
Mailing Address - Phone:863-401-4401
Mailing Address - Fax:863-410-1108
Practice Address - Street 1:1510 S LAKE ROCHELLE DR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-9645
Practice Address - Country:US
Practice Address - Phone:321-759-2562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QS0010X
FLME121120261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent HealthGroup - Multi-Specialty