Provider Demographics
NPI:1114969888
Name:PUTT, HEIDI LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:LYNN
Last Name:PUTT
Suffix:
Gender:F
Credentials:DO
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 1847
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1847
Mailing Address - Country:US
Mailing Address - Phone:231-728-1700
Mailing Address - Fax:231-728-1675
Practice Address - Street 1:1675 LEAHY ST
Practice Address - Street 2:SUITE 324B
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-5500
Practice Address - Country:US
Practice Address - Phone:231-728-1700
Practice Address - Fax:231-728-1675
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015565207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4551829Medicaid
MIMI1763017OtherMEDICARE