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General NPI Number Information
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NPI Number | 1447204672
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Entity Type | Individual
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Provider Name | MARTA ELISE HEILBRUN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 5217 S STATE ST STE 200
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City | MURRAY
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State | UT
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Zip | 84107-4812
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Country | US
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Telephone | 801-313-4118
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30180
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City | SALT LAKE CITY
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State | UT
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Zip | 84130-0180
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Country | US
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Telephone |
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 78860
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 200400042
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 327419-1205
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License Number State | UT
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