Provider Demographics
NPI:1801335815
Name:MISHA MAX HELLER, M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:MISHA MAX HELLER, M.D., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MISHA
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:HELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-498-2459
Mailing Address - Street 1:1760 TERMINO AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2169
Mailing Address - Country:US
Mailing Address - Phone:562-498-2459
Mailing Address - Fax:562-494-8285
Practice Address - Street 1:1760 TERMINO AVE STE 114
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2169
Practice Address - Country:US
Practice Address - Phone:562-498-2459
Practice Address - Fax:562-494-8285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-23
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty