Provider Demographics
NPI:1508927369
Name:HEIM, MICHAEL PATRICK (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATRICK
Last Name:HEIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3913 W KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8623
Mailing Address - Country:US
Mailing Address - Phone:813-326-4092
Mailing Address - Fax:813-384-3108
Practice Address - Street 1:2102 S MACDILL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5934
Practice Address - Country:US
Practice Address - Phone:813-384-3107
Practice Address - Fax:813-384-3108
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9106207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAZ309ZOtherMEDICARE
FLAZ309ZOtherMEDICARE