Healthcare Provider Details

I. General information

NPI: 1154881316
Provider Name (Legal Business Name): MIA ANNALISE HEILIGENSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 OSTRUM ST STE 303
FOUNTAIN HILL PA
18015-1152
US

IV. Provider business mailing address

701 OSTRUM ST STE 303
FOUNTAIN HILL PA
18015-1152
US

V. Phone/Fax

Practice location:
  • Phone: 608-335-7556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD496818
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: