Healthcare Provider Details

I. General information

NPI: 1700160488
Provider Name (Legal Business Name): STEVEN FRED HEINZE HAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2011
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5089 S 1500 W
RIVERDALE UT
84405-3969
US

IV. Provider business mailing address

215 SHUMAN BLVD STE 401
NAPERVILLE IL
60563-8458
US

V. Phone/Fax

Practice location:
  • Phone: 801-866-1312
  • Fax: 801-627-8020
Mailing address:
  • Phone: 331-229-8208
  • Fax: 978-313-6824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number5496870-4601
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: