Provider Demographics
NPI:1598970774
Name:HEISEL, DIANE EDWARDS (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:EDWARDS
Last Name:HEISEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:493 UPLAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9650
Mailing Address - Country:US
Mailing Address - Phone:734-475-3568
Mailing Address - Fax:
Practice Address - Street 1:8303 PLATT RD
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9773
Practice Address - Country:US
Practice Address - Phone:734-295-4228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010532232084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry