Provider Demographics
NPI:1922566652
Name:MATT A. HEILALA, DPM INC.
Entity Type:Organization
Organization Name:MATT A. HEILALA, DPM INC.
Other - Org Name:ALASKA FOOT & ANKLE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF PODIATRIC MEDICINE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEILALA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:907-569-3668
Mailing Address - Street 1:2250 E 42ND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5202
Mailing Address - Country:US
Mailing Address - Phone:907-569-3668
Mailing Address - Fax:907-569-3669
Practice Address - Street 1:3190 E MERIDIAN PARK LOOP STE 205
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7422
Practice Address - Country:US
Practice Address - Phone:907-569-3668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALASKA FOOT & ANKLE SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-12
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty