Basic Information
| Provider Information | |||||||||
| NPI: | 1962484816 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEISER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9369 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366910369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514600326 | ||||||||
| FaxNumber: | 2514602846 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 MORPHY AVE | ||||||||
| Address2: | |||||||||
| City: | FAIRHOPE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365321812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2519287205 | ||||||||
| FaxNumber: | 2514765460 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 10/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 22538 | AL | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000008569 | 05 | AL | MEDICAID | 51008569 | 01 | BCBS ALA | OTHER | 511-45892 | 01 | AL | BCBS | OTHER |