Provider Demographics
NPI:1396730743
Name:BOILINI, HENRY ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:ALEXANDER
Last Name:BOILINI
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 1:6900 TAVISTOCK LAKES BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7593
Mailing Address - Country:US
Mailing Address - Phone:407-476-4725
Mailing Address - Fax:407-873-4839
Practice Address - Street 1:6900 TAVISTOCK LAKES BLVD STE 400
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7593
Practice Address - Country:US
Practice Address - Phone:407-476-4725
Practice Address - Fax:407-987-3483
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE220412084P0800X
FLME951522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003276500Medicaid
FL53303OtherFLORIDA BLUE
FL003276500Medicaid