Provider Demographics
NPI:1609003896
Name:HARVEY S MISHNER MD PL
Entity Type:Organization
Organization Name:HARVEY S MISHNER MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MISHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-907-0588
Mailing Address - Street 1:7504 ABBEY GLN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2423
Mailing Address - Country:US
Mailing Address - Phone:941-907-0588
Mailing Address - Fax:941-373-6622
Practice Address - Street 1:11505 PALMBRUSH TRAIL
Practice Address - Street 2:SUITE 220
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5183
Practice Address - Country:US
Practice Address - Phone:941-907-0588
Practice Address - Fax:941-373-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84341207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX IDENTIFICATION
FLBZ177AMedicare PIN