Provider Demographics
NPI:1467603175
Name:HEYSE, PHILLIP B (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:B
Last Name:HEYSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ELIZABETH PL
Mailing Address - Street 2:SUITE 10 A
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3445
Mailing Address - Country:US
Mailing Address - Phone:937-228-4126
Mailing Address - Fax:937-228-0247
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:SUITE 10 A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3445
Practice Address - Country:US
Practice Address - Phone:937-228-4126
Practice Address - Fax:937-228-0247
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
OH35.095783208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH231761Medicare PIN