MEDICARE: DR. STEVE M HEILBRUNN MD

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	207RI0011X	Interventional Cardiology Physician	038252E	PA
2	207RI0011X	Interventional Cardiology Physician	49527	CO
3	207RI0011X	Interventional Cardiology Physician	40553	AZ
4	207RC0000X	Cardiovascular Disease Physician	40553	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12188574	OTHER	AZ	CAQH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700889425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVE M HEILBRUNN MD

Provider Business Mailing Address
First Line	:	1200 NORTH BEAVER STREET
Second Line	:	PAYER CREDENTIALING
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86001-3118
Country	:	US
Telephone Number	:	928-773-2559
Fax Number	:	928-213-6292

Provider Business Practice Location Address
First Line	:	294 STATE ROUTE 89A
Second Line	:	SUITE 107
City	:	COTTONWOOD
State	:	AZ
Zip	:	86326-3763
Country	:	US
Telephone Number	:	928-634-1331
Fax Number	:	928-634-3130

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	12/18/2015

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Directions to “ DR. STEVE M HEILBRUNN MD” Practice Location

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