MEDICARE: MARLOU B HEILAND 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	208800000X	Urology Physician	33507	AZ

General Provider Information

NPI Number	:	1730180431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLOU B HEILAND M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6423
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85246-6423
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1455 W CHANDLER BLVD
Second Line	:	BLDG B #8
City	:	CHANDLER
State	:	AZ
Zip	:	85224-6177
Country	:	US
Telephone Number	:	480-899-1696
Fax Number	:	480-963-6227

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	11/23/2022

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