Provider Demographics
NPI:1184006504
Name:HEIS, STEPHEN LAWRENCE (DO, MHP)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:LAWRENCE
Last Name:HEIS
Suffix:
Gender:M
Credentials:DO, MHP
Other - Prefix:MR
Other - First Name:STEPHEN
Other - Middle Name:LAWRENCE
Other - Last Name:HEIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4700 E GALBRAITH RD STE 300A
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-2754
Mailing Address - Country:US
Mailing Address - Phone:513-347-9999
Mailing Address - Fax:513-792-3239
Practice Address - Street 1:4700 E GALBRAITH RD STE 300A
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-2754
Practice Address - Country:US
Practice Address - Phone:513-347-9999
Practice Address - Fax:513-792-3239
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013725208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0355908Medicaid