Provider Demographics
NPI:1033158159
Name:HEADAPOHL, MARC (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:HEADAPOHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1850 WHITES RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-4801
Mailing Address - Country:US
Mailing Address - Phone:269-343-3900
Mailing Address - Fax:269-343-5640
Practice Address - Street 1:1850 WHITES RD
Practice Address - Street 2:SUITE 3
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-4801
Practice Address - Country:US
Practice Address - Phone:269-343-3900
Practice Address - Fax:269-343-5640
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301074898207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG91181Medicare UPIN
MIOC96159058Medicare ID - Type Unspecified