Provider Demographics
NPI:1396280681
Name:HIMES, MICHAEL ISAAC (PA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ISAAC
Last Name:HIMES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 37TH PL STE 104
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6586
Mailing Address - Country:US
Mailing Address - Phone:772-567-8482
Mailing Address - Fax:
Practice Address - Street 1:960 37TH PL STE 104
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6586
Practice Address - Country:US
Practice Address - Phone:772-567-8482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPAT9110071363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant