Provider Demographics
NPI:1447403134
Name:MICHAEL H. HENNESSEY, MD, PA
Entity Type:Organization
Organization Name:MICHAEL H. HENNESSEY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMBRISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-243-2229
Mailing Address - Street 1:907 MAR WALT DR
Mailing Address - Street 2:SUITE 2024
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6960
Mailing Address - Country:US
Mailing Address - Phone:850-243-2229
Mailing Address - Fax:850-862-0124
Practice Address - Street 1:907 MAR WALT DR
Practice Address - Street 2:SUITE 2024
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6960
Practice Address - Country:US
Practice Address - Phone:850-243-2229
Practice Address - Fax:850-862-0124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83428207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H79573Medicare UPIN