Organization
BRANDON PSYCHIATRIC GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. HANY BOTROS MIKHAIL M.D. (PRESIDENT)
(678) 923-6025
Entity
Organization
Contact information
Practice address
106 W WINDHORST RD, BRANDON, FL 33510-2455
(678) 923-6025
Mailing address
PO BOX 1584, CUMMING, GA 30028-1584
(678) 923-6025
(813) 413-6660
Taxonomy
Speciality
Code
Description
License number
State
2084B0040X
Behavioral Neurology & Neuropsychiatry Physician
Primary
95351
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
275940302
—
FL
Enumeration date
08/13/2014
Last updated
02/06/2019
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