MEDICARE: DR. MICHAEL C HEAGNEY MD

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	ME45251	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619994456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL C HEAGNEY MD

Provider Business Mailing Address
First Line	:	4550 GRASSY POINT BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-9179
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 GRASSY POINT BLVD
Second Line	:
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-9179
Country	:	US
Telephone Number	:	941-624-5634
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	06/02/2008

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