Provider Demographics
NPI:1366690026
Name:WILLIAM F HECKERT D.O. P.C.
Entity Type:Organization
Organization Name:WILLIAM F HECKERT D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HECKERT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-372-2253
Mailing Address - Street 1:2815 S PENNSYLVANIA AVE
Mailing Address - Street 2:STE 107
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-3496
Mailing Address - Country:US
Mailing Address - Phone:517-372-2253
Mailing Address - Fax:517-372-2287
Practice Address - Street 1:2815 S PENNSYLVANIA AVE
Practice Address - Street 2:STE 107
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-3496
Practice Address - Country:US
Practice Address - Phone:517-372-2253
Practice Address - Fax:517-372-2287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006399207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0753335364OtherBLUE CROSS
MI1369005 TYPE 11Medicaid
MI5333536OtherMEDICARE ID-TYPE UNSPECIFIED
MI03-00584OtherPHP
MI03-00584OtherPHP