Provider Demographics
NPI:1457311797
Name:FRANKEL, HEIDI LEE (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LEE
Last Name:FRANKEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 SAN PABLO STREET
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5320
Mailing Address - Country:US
Mailing Address - Phone:323-442-5907
Mailing Address - Fax:323-442-6020
Practice Address - Street 1:1510 SAN PABLO STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5320
Practice Address - Country:US
Practice Address - Phone:323-442-5907
Practice Address - Fax:323-442-6020
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD39953208600000X
TXM1682208D00000X
CAG891802086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176092801Medicaid
MD073831000Medicaid
CAGH863ZMedicaid
CAGH863ZMedicaid
TX8D9161Medicare ID - Type Unspecified
MD073831000Medicaid