Provider Demographics
NPI:1619923984
Name:MEISENBACH, HARRY KEVIN (MD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:KEVIN
Last Name:MEISENBACH
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:PO BOX 7055
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89510-7055
Mailing Address - Country:US
Mailing Address - Phone:775-823-1999
Mailing Address - Fax:775-823-1996
Practice Address - Street 1:1155 MILL ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1576
Practice Address - Country:US
Practice Address - Phone:775-982-8100
Practice Address - Fax:775-982-4161
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV236412085R0202X
FLME928112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53067OtherBLUE CROSS OF FLORIDA
FL53067OtherBCBS FL
FL239216OtherAVMED
FL270855OtherAVMED
FLP00603842OtherRAILROAD MEDICARE
FLP00603845OtherRAILROAD MEDICARE
FL275537800Medicaid
I57403Medicare UPIN
FL275537800Medicaid
FLU7846VMedicare PIN
FL270855OtherAVMED
FLU7846WMedicare PIN
U7846ZMedicare PIN