Provider Demographics
NPI:1417065434
Name:ACKEN, HERBERT W (MD)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:W
Last Name:ACKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 BATES AVE SW
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-2953
Mailing Address - Country:US
Mailing Address - Phone:863-299-7704
Mailing Address - Fax:863-297-9772
Practice Address - Street 1:116 BATES AVE SW
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-2953
Practice Address - Country:US
Practice Address - Phone:863-299-7704
Practice Address - Fax:863-297-9772
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0022227207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD56520Medicare UPIN
FL53445Medicare ID - Type Unspecified