Provider Demographics
NPI:1598944589
Name:CHARLES E. HETH, D.O., P.C.
Entity Type:Organization
Organization Name:CHARLES E. HETH, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-226-1490
Mailing Address - Street 1:42855 GARFIELD RD STE 105
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
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 STE 105
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4125700Medicaid
E49500Medicare UPIN