MEDICARE: MARK ALAN HEISER HIS

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	237700000X	Hearing Instrument Specialist	HADE9721	AZ

General Provider Information

NPI Number	:	1619449477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ALAN HEISER HIS

Provider Business Mailing Address
First Line	:	1930 MESQUITE AVE
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5674
Country	:	US
Telephone Number	:	928-855-5252
Fax Number	:	928-855-5283

Provider Business Practice Location Address
First Line	:	1930 MESQUITE AVE
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-5674
Country	:	US
Telephone Number	:	928-855-5252
Fax Number	:	928-855-5283

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

Provider Enumeration Date	:	12/18/2018
Last Update Date	:	12/18/2018

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Directions to “ MARK ALAN HEISER HIS” Practice Location

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