MEDICARE: DR. DAVID HEISE 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	207Q00000X	Family Medicine Physician	ME0083299	FL
2	208M00000X	Hospitalist Physician	ME83299	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
2	ME83299	OTHER	FL	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1740353465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID HEISE MD

Provider Business Mailing Address
First Line	:	735 DUNLAWTON AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-9226
Country	:	US
Telephone Number	:	888-808-0488
Fax Number	:	386-872-4232

Provider Business Practice Location Address
First Line	:	735 DUNLAWTON AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-9226
Country	:	US
Telephone Number	:	888-808-0488
Fax Number	:	386-872-4232

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	10/15/2024

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Directions to “ DR. DAVID HEISE MD” Practice Location

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