Healthcare Provider Details

I. General information

NPI: 1538117825
Provider Name (Legal Business Name): JOHN A. HEIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3998 RED LION RD SUITE 214
PHILADELPHIA PA
19114-1436
US

IV. Provider business mailing address

P. O. BOX 8500 - 6300
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-612-5050
  • Fax: 215-612-5214
Mailing address:
  • Phone: 215-807-8000
  • Fax: 215-807-8235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD423045
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: