Individual
MICHAEL WILLIAM HEASLET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
4950 BARRANCA PKWY, SUITE 308, IRVINE, CA 92604-4671
(949) 651-1202
(949) 552-9493
Mailing address
4950 BARRANCA PKWY, SUITE 308, IRVINE, CA 92604-4671
(949) 651-1202
(949) 552-9493
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E2056
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95-3539063
FEDERAL TAX ID
CA
01
—
E2056
STATE LICENSE NUMBER
CA
Enumeration date
05/12/2006
Last updated
09/28/2011
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