Provider Demographics
NPI:1306945993
Name:GIRGIS, HANY I (MD)
Entity type:Individual
Prefix:
First Name:HANY
Middle Name:I
Last Name:GIRGIS
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 1:245 S COURTENAY PKWY
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4856
Mailing Address - Country:US
Mailing Address - Phone:321-453-5326
Mailing Address - Fax:321-452-8507
Practice Address - Street 1:245 S COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32952-4856
Practice Address - Country:US
Practice Address - Phone:321-453-5326
Practice Address - Fax:321-452-8507
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063928207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373055700Medicaid
FL18991Medicare ID - Type Unspecified
FLF48518Medicare UPIN