MEDICARE: MR. ALFRED P HEINEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA3697	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588658165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALFRED P HEINEN PA-C

Provider Business Mailing Address
First Line	:	5301 S CONGRESS AVE
Second Line	:	BLDG. #300
City	:	ATLANTIS
State	:	FL
Zip	:	33462-1149
Country	:	US
Telephone Number	:	561-548-4900
Fax Number	:	561-548-4902

Provider Business Practice Location Address
First Line	:	5301 S CONGRESS AVE
Second Line	:	BLDG. #300
City	:	ATLANTIS
State	:	FL
Zip	:	33462-1149
Country	:	US
Telephone Number	:	561-548-4900
Fax Number	:	561-548-4902

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	02/10/2022

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