Healthcare Provider Details

I. General information

NPI: 1538470547
Provider Name (Legal Business Name): MICHAEL HEISLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

IV. Provider business mailing address

593 EDDY ST
PROVIDENCE RI
02903-4923
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-5184
  • Fax: 401-444-5017
Mailing address:
  • Phone: 401-444-5184
  • Fax: 401-444-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberLP02077
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: