Provider Demographics
NPI:1396710109
Name:STORPER, HENRY MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:MICHAEL
Last Name:STORPER
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 1:10535 SW 128TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-5545
Mailing Address - Country:US
Mailing Address - Phone:305-251-0679
Mailing Address - Fax:305-252-0575
Practice Address - Street 1:9275 SW 152ND ST
Practice Address - Street 2:SUITE 108 B
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1701
Practice Address - Country:US
Practice Address - Phone:305-252-0533
Practice Address - Fax:305-252-0575
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME259172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056090100Medicaid
FL056090100Medicaid
FLD60007Medicare UPIN
FL92248Medicare ID - Type Unspecified