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NPI Code Detail

MEDICARE: RYAN H. HEISE M.D.

MEDICARE: RYAN H. HEISE 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
1207R00000XInternal Medicine PhysicianL8072TX

General Provider Information

NPI Number : 1578506010
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN H. HEISE M.D.
Provider Business Mailing Address
First Line : 801 E CAMPBELL RD STE 400
Second Line :
City : RICHARDSON
State : TX
Zip : 75081-6797
Country : US
Telephone Number : 214-377-3700
Fax Number :
Provider Business Practice Location Address
First Line : 7502 GREENVILLE AVE
Second Line :
City : DALLAS
State : TX
Zip : 75231-3802
Country : US
Telephone Number : 972-600-2223
Fax Number : 972-863-6020
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 10/10/2019

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