Provider Demographics
NPI:1215962709
Name:HENNE, TIMOTHY JAMES (DPM)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:HENNE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3190 CITRUS TOWER BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6886
Mailing Address - Country:US
Mailing Address - Phone:352-242-2502
Mailing Address - Fax:352-242-0316
Practice Address - Street 1:3150 CITRUS TOWER BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6802
Practice Address - Country:US
Practice Address - Phone:352-242-2502
Practice Address - Fax:352-242-0316
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO3047213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4690780001OtherPALMETTO GBA
FL043604213OtherCIGNA
FL043604213OtherTRICARE
FL65802OtherBC/BS
FL340361100Medicaid
FLP00071261OtherRAILROAD MEDICARE
FL043604213OtherCIGNA
FLU0003YMedicare PIN
FL340361100Medicaid