Provider Demographics
NPI:1407899560
Name:DINKLA, HENDRIK (ME53372)
Entity Type:Individual
Prefix:DR
First Name:HENDRIK
Middle Name:
Last Name:DINKLA
Suffix:
Gender:M
Credentials:ME53372
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10050 SW INNOVATION WAY SUITE 102
Mailing Address - Street 2:10050 SW INNOVATION WAY SUITE 102
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987
Mailing Address - Country:US
Mailing Address - Phone:772-344-3811
Mailing Address - Fax:772-335-2422
Practice Address - Street 1:10050 SW INNOVATION WAY SUITE 102
Practice Address - Street 2:10050 SW INNOVATION WAY SUITE 102
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34987
Practice Address - Country:US
Practice Address - Phone:772-344-3811
Practice Address - Fax:772-335-2422
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME533722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0447625-00Medicaid
FLD21073Medicare UPIN