Provider Demographics
NPI:1477519338
Name:HENKEL, BERT J (DPM)
Entity Type:Individual
Prefix:DR
First Name:BERT
Middle Name:J
Last Name:HENKEL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 HOLLYWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6634
Mailing Address - Country:US
Mailing Address - Phone:954-981-8000
Mailing Address - Fax:954-981-8002
Practice Address - Street 1:4301 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6634
Practice Address - Country:US
Practice Address - Phone:954-981-8000
Practice Address - Fax:954-981-8002
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2555213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE0071Medicare ID - Type Unspecified
FLU61026Medicare UPIN