Healthcare Provider Details

I. General information

NPI: 1497863088
Provider Name (Legal Business Name): STEPHEN EDWARD HEINZMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 MEDICAL PARK DR E STE 308
BIRMINGHAM AL
35235-3433
US

IV. Provider business mailing address

52 MEDICAL PARK DR E SUITE NUMBER 308
BIRMINGHAM AL
35235-3430
US

V. Phone/Fax

Practice location:
  • Phone: 205-838-3025
  • Fax: 205-838-3897
Mailing address:
  • Phone: 205-838-3025
  • Fax: 205-838-3897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number00020932
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: