Provider Demographics
NPI:1972761567
Name:HEIMOWITZ, TODD BLAKE (DO)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:BLAKE
Last Name:HEIMOWITZ
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 1:4300 ALTON RD
Mailing Address - Street 2:DE HIRSCH MEYER TOWER STE 2070
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2948
Mailing Address - Country:US
Mailing Address - Phone:305-674-2690
Mailing Address - Fax:305-674-2693
Practice Address - Street 1:4300 ALTON RD
Practice Address - Street 2:DE HIRSCH MEYER TOWER STE 2070
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33140-2948
Practice Address - Country:US
Practice Address - Phone:305-674-2690
Practice Address - Fax:305-674-2693
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8372207RI0011X
FLOS 8372207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03412Medicare PIN