Healthcare Provider Details

I. General information

NPI: 1184817561
Provider Name (Legal Business Name): CHRISTIAN VAN DEN HEUVEL SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2848 S SEACREST BLVD
BOYNTON BEACH FL
33435-7935
US

IV. Provider business mailing address

2848 S SEACREST BLVD
BOYNTON BEACH FL
33435
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-8844
  • Fax: 561-737-8989
Mailing address:
  • Phone: 561-737-8844
  • Fax: 561-737-8989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME20069
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: