Provider Demographics
NPI:1659368751
Name:BERDIN, HEIDI A (MD)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:A
Last Name:BERDIN
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:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86405-0650
Mailing Address - Country:US
Mailing Address - Phone:928-855-6966
Mailing Address - Fax:928-855-6974
Practice Address - Street 1:1830 MESQUITE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5885
Practice Address - Country:US
Practice Address - Phone:928-855-6966
Practice Address - Fax:928-855-6974
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42565207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ479811Medicaid
AZ479811Medicaid
AZH03760Medicare UPIN