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General NPI Number Information
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NPI Number | 1346773256
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Entity Type | Individual
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Provider Name | DANIEL JOSEPH HEIDENBERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/07/2017
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 3743 MARYWEATHER LN
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-7782
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Country | US
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Telephone | 813-607-4655
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Fax | 813-607-4656
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Provider Business Mailing Address
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Address Line | 5015 W NASSAU ST
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City | TAMPA
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State | FL
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Zip | 33607-3814
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Country | US
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Telephone | 881-356-0196
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Fax | 813-356-0197
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME166541
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License Number State | FL
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