Provider Demographics
NPI:1497863088
Name:HEINZMAN, STEPHEN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EDWARD
Last Name:HEINZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 MEDICAL PARK DR E
Mailing Address - Street 2:SUITE NUMBER 308
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3430
Mailing Address - Country:US
Mailing Address - Phone:205-838-3025
Mailing Address - Fax:205-838-3897
Practice Address - Street 1:52 MEDICAL PARK DR E STE 308
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3433
Practice Address - Country:US
Practice Address - Phone:205-838-3025
Practice Address - Fax:205-838-3897
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000209322086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051076986OtherBLUE CROSS BLUE SHIELD
AL000076986Medicaid
ALF63076OtherVIVA
AL17-10068OtherUNITED HEALTHCARE
AL051076986OtherBLUE CROSS BLUE SHIELD