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NPI Code Detail

MEDICARE: MICHAEL DANIEL HEAFNER MD

MEDICARE: MICHAEL DANIEL HEAFNER 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
1207T00000XNeurological Surgery Physician38354NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1140004696OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811995715
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL DANIEL HEAFNER MD
Provider Business Mailing Address
First Line : 225 BALDWIN AVE
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-3109
Country : US
Telephone Number : 704-376-1605
Fax Number : 704-335-8448
Provider Business Practice Location Address
First Line : 225 BALDWIN AVE
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-3109
Country : US
Telephone Number : 704-376-1605
Fax Number : 704-335-8448
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2005
Last Update Date : 10/23/2012

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1225036106 — CHARLES SCOTT MCLANAHAN MD
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Directions to “ MICHAEL DANIEL HEAFNER MD” Practice Location

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