Provider Demographics
NPI:1346773256
Name:HEIDENBERG, DANIEL JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:HEIDENBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5015 W NASSAU ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-3814
Mailing Address - Country:US
Mailing Address - Phone:881-356-0196
Mailing Address - Fax:813-356-0197
Practice Address - Street 1:3743 MARYWEATHER LN
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-7782
Practice Address - Country:US
Practice Address - Phone:813-607-4655
Practice Address - Fax:813-607-4656
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2024-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME166541208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology