Provider Demographics
NPI:1619923984
Name:MEISENBACH, HARRY KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:KEVIN
Last Name:MEISENBACH
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 1:6716 NW 11TH PLACE
Mailing Address - Street 2:STE 200
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4215
Mailing Address - Country:US
Mailing Address - Phone:352-331-9729
Mailing Address - Fax:352-331-0136
Practice Address - Street 1:6716 NW 11TH PLACE
Practice Address - Street 2:STE 200
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4215
Practice Address - Country:US
Practice Address - Phone:352-331-9729
Practice Address - Fax:352-331-0136
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME928112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00603845OtherRAILROAD MEDICARE
FL270855OtherAVMED
FL275537800Medicaid
FL239216OtherAVMED
FL53067OtherBCBS FL
FL53067OtherBLUE CROSS OF FLORIDA
FLP00603842OtherRAILROAD MEDICARE
I57403Medicare UPIN
FL275537800Medicaid
FLU7846VMedicare PIN
FL270855OtherAVMED
FLU7846WMedicare PIN
U7846ZMedicare PIN