Provider Demographics
NPI:1043731904
Name:HENSLEY MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:HENSLEY MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-501-4468
Mailing Address - Street 1:26907 FOGGY CREEK RD STE 102
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6778
Mailing Address - Country:US
Mailing Address - Phone:813-501-4468
Mailing Address - Fax:813-501-8620
Practice Address - Street 1:26907 FOGGY CREEK RD STE 102
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6778
Practice Address - Country:US
Practice Address - Phone:813-501-4468
Practice Address - Fax:813-501-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty