Provider Demographics
NPI:1265669709
Name:HEIL, ROSS AUGUST (DO)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:AUGUST
Last Name:HEIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 WINSTED DR
Mailing Address - Street 2:STE 1
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-4696
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1615 WINSTED DR
Practice Address - Street 2:STE 1
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4696
Practice Address - Country:US
Practice Address - Phone:574-537-1625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004580A207RG0100X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN184520032Medicare PIN