Provider Demographics
NPI:1477855815
Name:D.H. MEDICAL, LLC
Entity Type:Organization
Organization Name:D.H. MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEISE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-235-1489
Mailing Address - Street 1:226 N NOVA RD
Mailing Address - Street 2:SUITE 184
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5124
Mailing Address - Country:US
Mailing Address - Phone:386-235-1489
Mailing Address - Fax:386-615-8208
Practice Address - Street 1:226 N NOVA RD
Practice Address - Street 2:SUITE 184
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5124
Practice Address - Country:US
Practice Address - Phone:386-235-1489
Practice Address - Fax:386-615-8208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2011-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262487700Medicaid
FL262487700Medicaid
FL06216YMedicare PIN