Provider Demographics
NPI:1477749539
Name:NORTHLAND FAMILY PRACTICE LTD
Entity Type:Organization
Organization Name:NORTHLAND FAMILY PRACTICE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:HEILMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-256-3548
Mailing Address - Street 1:220 NE 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-1002
Mailing Address - Country:US
Mailing Address - Phone:605-256-3548
Mailing Address - Fax:605-256-6808
Practice Address - Street 1:220 NE 9TH ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-1002
Practice Address - Country:US
Practice Address - Phone:605-256-3548
Practice Address - Fax:605-256-6808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5278Medicare PIN