MEDICARE: BRENTEN LANCE HEEKE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	MD.34747	AL

General Provider Information

NPI Number	:	1033538103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENTEN LANCE HEEKE M.D.

Provider Business Mailing Address
First Line	:	619 19TH ST S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35249-6830
Country	:	US
Telephone Number	:	205-934-3166
Fax Number	:

Provider Business Practice Location Address
First Line	:	619 19TH ST S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35249-6830
Country	:	US
Telephone Number	:	205-934-3166
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/15/2014
Last Update Date	:	06/06/2019

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