Provider Demographics
NPI:1225251739
Name:ELIZABETH HEIL MD INC
Entity Type:Organization
Organization Name:ELIZABETH HEIL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:PAIGE
Authorized Official - Last Name:HEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-767-8555
Mailing Address - Street 1:521 W STATE ROAD 434
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-4984
Mailing Address - Country:US
Mailing Address - Phone:407-767-8555
Mailing Address - Fax:407-767-5444
Practice Address - Street 1:521 W STATE ROAD 434
Practice Address - Street 2:SUITE 302
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4984
Practice Address - Country:US
Practice Address - Phone:407-767-8555
Practice Address - Fax:407-767-5444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE61775Medicare UPIN
FL30799XMedicare PIN