Provider Demographics
NPI:1679934996
Name:BORIS HAVKIN PLLC
Entity Type:Organization
Organization Name:BORIS HAVKIN PLLC
Other - Org Name:HAVKIN UROLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-500-4545
Mailing Address - Street 1:3021 W EAU GALLIE BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-7005
Mailing Address - Country:US
Mailing Address - Phone:321-500-4545
Mailing Address - Fax:
Practice Address - Street 1:3021 W EAU GALLIE BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32934-7005
Practice Address - Country:US
Practice Address - Phone:321-500-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-14
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90111208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty