MEDICARE: MATT A. HEILALA, DPM INC.

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	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1922566652
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATT A. HEILALA, DPM INC.

Provider Business Mailing Address
First Line	:	2250 E 42ND AVE STE 200
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5202
Country	:	US
Telephone Number	:	907-569-3668
Fax Number	:	907-569-3669

Provider Business Practice Location Address
First Line	:	3190 E MERIDIAN PARK LOOP STE 205
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7422
Country	:	US
Telephone Number	:	907-569-3668
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR OF PODIATRIC MEDICINE/OWNER
Name	:	MATT A HEILALA
Credential	:	DPM
Telephone Number	:	907-569-3668

Provider Enumeration Date	:	03/12/2019
Last Update Date	:	07/16/2019

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