Provider Demographics
NPI:1669408217
Name:JEFFREY A HEITMANN MD PA
Entity type:Organization
Organization Name:JEFFREY A HEITMANN MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEITMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-513-0053
Mailing Address - Street 1:1660 MEDICAL BLVD
Mailing Address - Street 2:#300
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1413
Mailing Address - Country:US
Mailing Address - Phone:239-513-0053
Mailing Address - Fax:239-596-0900
Practice Address - Street 1:1660 MEDICAL BLVD
Practice Address - Street 2:#300
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1413
Practice Address - Country:US
Practice Address - Phone:239-513-0053
Practice Address - Fax:239-596-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE14681Medicare UPIN
FLAH199ZMedicare Oscar/Certification
FLI06776Medicare UPIN
FLG52952Medicare UPIN