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General NPI Number Information
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NPI Number | 1477588655
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Entity Type | Individual
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Provider Name | KENNETH BRYAN HELLER MD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 08/23/2007
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Provider Practice Location Address
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Address Line | 113 WILDWOOD DR
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City | BELTON
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State | SC
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Zip | 29627-9687
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Country | US
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Telephone | 864-940-9701
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Fax | 864-338-8760
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Provider Business Mailing Address
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Address Line | PO BOX 846
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City | BELTON
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State | SC
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Zip | 29627-0846
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Country | US
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Telephone | 864-940-9701
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Fax | 864-338-8760
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 09331
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License Number State | SC
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