Provider Demographics
NPI:1174657449
Name:BRIAN D HEYMAN, DO, PLC
Entity Type:Organization
Organization Name:BRIAN D HEYMAN, DO, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:810-695-9920
Mailing Address - Street 1:10683 S SAGINAW ST STE B
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-8127
Mailing Address - Country:US
Mailing Address - Phone:810-695-9920
Mailing Address - Fax:
Practice Address - Street 1:10683 S SAGINAW ST STE B
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8127
Practice Address - Country:US
Practice Address - Phone:810-695-9920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101014587207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI9390581OtherPHCS
MI4729810Medicaid
MI141242OtherPREFERRED CHOICES
MI2463822OtherCIGNA
MI1000498OtherHEALTHPLUS
MI1652510975OtherBCBS
MI2463822OtherCIGNA
MIP17760001Medicare ID - Type Unspecified