Provider Demographics
NPI:1750390175
Name:MCKINNEY - BOZORG, HELENA ELLEN (MD)
Entity type:Individual
Prefix:
First Name:HELENA
Middle Name:ELLEN
Last Name:MCKINNEY - BOZORG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HELENA
Other - Middle Name:ELLEN
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2465 MCMULLEN-BOOTH ROAD
Mailing Address - Street 2:CLEARWATER PRIMARY CARE CENTER
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1368
Mailing Address - Country:US
Mailing Address - Phone:727-725-5224
Mailing Address - Fax:727-799-2183
Practice Address - Street 1:2465 MCMULLEN-BOOTH ROAD
Practice Address - Street 2:CLEARWATER PRIMARY CARE CENTER
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1368
Practice Address - Country:US
Practice Address - Phone:727-725-5224
Practice Address - Fax:727-799-2183
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94348207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273982800Medicaid
FL30902XMedicare PIN
FL273982800Medicaid