Provider Demographics
NPI:1699754762
Name:HAN, HELENA (MD)
Entity type:Individual
Prefix:
First Name:HELENA
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HELENA
Other - Middle Name:
Other - Last Name:OLIVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12600 PEMBROKE RD STE 308
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2544
Mailing Address - Country:US
Mailing Address - Phone:954-436-3300
Mailing Address - Fax:
Practice Address - Street 1:12600 PEMBROKE RD STE 308
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2544
Practice Address - Country:US
Practice Address - Phone:954-436-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75030207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259981300Medicaid
FL42815OtherBCBS
FL42815OtherBCBS
G84573Medicare UPIN
FL42815UMedicare ID - Type Unspecified
FL42815VMedicare ID - Type Unspecified
FL42815XMedicare ID - Type Unspecified
FL42815ZMedicare ID - Type Unspecified