Provider Demographics
NPI:1629036801
Name:HEYSEK, RANDY V (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:V
Last Name:HEYSEK
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:PO BOX 90758
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33804-0758
Mailing Address - Country:US
Mailing Address - Phone:407-566-9899
Mailing Address - Fax:407-566-9893
Practice Address - Street 1:40107 HWY 27
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837
Practice Address - Country:US
Practice Address - Phone:863-419-0692
Practice Address - Fax:863-419-1695
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME512222085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048207200Medicaid
FL04944OtherBLUE CROSS BLUE SHIELD
FL0471260008Medicare NSC
FL048207200Medicaid
FL04944ZMedicare PIN
FL04944BMedicare PIN
D21000Medicare UPIN
FL920006831Medicare PIN
FLD21000Medicare UPIN