Provider Demographics
NPI:1710037692
Name:HEID, MICHAEL (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:HEID
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:PO BOX 11407
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-1431
Mailing Address - Country:US
Mailing Address - Phone:361-572-0333
Mailing Address - Fax:361-703-5101
Practice Address - Street 1:801 E 6TH ST. STE. 602
Practice Address - Street 2:BAYSIDE SURGICAL ASSOCIATES
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401
Practice Address - Country:US
Practice Address - Phone:850-913-6960
Practice Address - Fax:573-331-5079
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006023537208600000X
FLOS70962086S0127X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1710037692Medicaid
AR165402003Medicaid
MO502944OtherANTHEM BCBS
KY7100044890Medicaid
MO200184604Medicaid
761287OtherHEALTHLINK
P00433989OtherRAILROAD MEDICARE
P00433989OtherRAILROAD MEDICARE
MO200184604Medicaid