Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD042242L | PA |
Y | 111NI0900X | Internist | MD042242L | PA |
NPI | 1003804162 |
---|---|
Provider Name | Michael J Heise |
First Address | Mc Murray, PA 15317-2690 |
Second Address | Mc Murray, PA 15317-2690 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 07/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001237481 | (05) | PA |
E82441 | (02) | PA |