Provider Demographics
NPI:1427145168
Name:HEIMOWITZ, GARY LEWIS (DPM)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LEWIS
Last Name:HEIMOWITZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7800 W OAKLAND PARK BLVD
Mailing Address - Street 2:C 108
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6741
Mailing Address - Country:US
Mailing Address - Phone:954-741-6060
Mailing Address - Fax:954-476-0350
Practice Address - Street 1:7800 W OAKLAND PARK BLVD
Practice Address - Street 2:C 108
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6741
Practice Address - Country:US
Practice Address - Phone:954-741-6060
Practice Address - Fax:954-476-0350
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL462213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041336400Medicaid
FL87235Medicare ID - Type Unspecified
FL041336400Medicaid