Provider Demographics
NPI:1407328693
Name:DORVIL, HANCEAU (MD)
Entity type:Individual
Prefix:
First Name:HANCEAU
Middle Name:
Last Name:DORVIL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:HANCEAU
Other - Middle Name:
Other - Last Name:DORVIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DR HANCEAU DORVIL MD
Mailing Address - Street 1:5190 NW 167TH ST STE 109
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6329
Mailing Address - Country:US
Mailing Address - Phone:305-851-2860
Mailing Address - Fax:866-539-7038
Practice Address - Street 1:5190 NW 167TH ST STE 109
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6329
Practice Address - Country:US
Practice Address - Phone:305-851-2860
Practice Address - Fax:866-539-7038
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1655208D00000X
FL9295958363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123803100Medicaid