Provider Demographics
NPI:1053478495
Name:DUNNIWAY, HEIDI M (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:M
Last Name:DUNNIWAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13059
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4021
Mailing Address - Country:US
Mailing Address - Phone:812-485-1220
Mailing Address - Fax:
Practice Address - Street 1:1116 MILLIS AVE
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-2204
Practice Address - Country:US
Practice Address - Phone:812-485-1400
Practice Address - Fax:812-485-1401
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050112A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200221210Medicaid
ING98566Medicare UPIN
IN267650RMedicare PIN
ING98566Medicare UPIN