Healthcare Provider Details

I. General information

NPI: 1710037692
Provider Name (Legal Business Name): MICHAEL HEID DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SHIRCLIFF WAY STE 625
JACKSONVILLE FL
32204-4776
US

IV. Provider business mailing address

3 SHIRCLIFF WAY STE 625
JACKSONVILLE FL
32204-4776
US

V. Phone/Fax

Practice location:
  • Phone: 904-308-6900
  • Fax: 904-308-6927
Mailing address:
  • Phone: 904-308-6900
  • Fax: 904-308-6927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2006023537
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberOS7096
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberOS7096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: