Provider Demographics
NPI:1336130632
Name:HETH, CHARLES E (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:HETH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:42855 GARFIELD RD
Mailing Address - Street 2:STE 105
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-5027
Mailing Address - Country:US
Mailing Address - Phone:586-226-1387
Mailing Address - Fax:586-226-1859
Practice Address - Street 1:42855 GARFIELD RD
Practice Address - Street 2:STE 105
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-5027
Practice Address - Country:US
Practice Address - Phone:586-226-1387
Practice Address - Fax:586-226-1859
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2012-05-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101009233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E49500Medicare UPIN
0M83060Medicare ID - Type Unspecified