MEDICARE: DR. KENNETH C HEIST D.O.

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	207W00000X	Ophthalmology Physician	OS006682L	PA

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	:	1730269481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH C HEIST D.O.

Provider Business Mailing Address
First Line	:	2301 S 13TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-3505
Country	:	US
Telephone Number	:	215-271-6900
Fax Number	:	215-271-8740

Provider Business Practice Location Address
First Line	:	2301 S 13TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-3505
Country	:	US
Telephone Number	:	215-271-6900
Fax Number	:	215-271-8740

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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