Healthcare Provider Details

I. General information

NPI: 1598760373
Provider Name (Legal Business Name): MICHAEL ALAN HEISMAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 N JACKSON AVE STE 200
SAN JOSE CA
95116-1909
US

IV. Provider business mailing address

175 N JACKSON AVE STE 200
SAN JOSE CA
95116-1909
US

V. Phone/Fax

Practice location:
  • Phone: 408-384-7160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE02316
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: