Provider Demographics
NPI:1275260960
Name:HEVEN MEDICAL
Entity Type:Organization
Organization Name:HEVEN MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:I
Authorized Official - Last Name:PANIK
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:313-770-1336
Mailing Address - Street 1:27789 MOUND RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092-2697
Mailing Address - Country:US
Mailing Address - Phone:313-770-1336
Mailing Address - Fax:
Practice Address - Street 1:27789 MOUND RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-2697
Practice Address - Country:US
Practice Address - Phone:313-770-1336
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment