MEDICARE: DR. J MICHAEL HEIDER DDS

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	1223G0001X	General Practice Dentistry	DN00009225	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	:	1609879667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. J MICHAEL HEIDER DDS

Provider Business Mailing Address
First Line	:	2026 NE 19TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305-2509
Country	:	US
Telephone Number	:	954-566-5428
Fax Number	:	954-564-6043

Provider Business Practice Location Address
First Line	:	2026 NE 19TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33305-2509
Country	:	US
Telephone Number	:	954-566-5428
Fax Number	:	954-564-6043

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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