Provider Demographics
NPI:1073581450
Name:HEISE, VIRA C (MD)
Entity Type:Individual
Prefix:DR
First Name:VIRA
Middle Name:C
Last Name:HEISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:560 W MITCHELL ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2275
Mailing Address - Country:US
Mailing Address - Phone:231-487-2460
Mailing Address - Fax:231-487-6596
Practice Address - Street 1:560 W MITCHELL ST
Practice Address - Street 2:SUITE 300
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2275
Practice Address - Country:US
Practice Address - Phone:231-487-2460
Practice Address - Fax:231-487-6596
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301048799207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104774510Medicaid
MI104774510Medicaid
0M74020013Medicare ID - Type Unspecified