Provider Demographics
NPI:1679707665
Name:HEERSINK DOVICH, MILA JACOBA (MD)
Entity Type:Individual
Prefix:
First Name:MILA
Middle Name:JACOBA
Last Name:HEERSINK DOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MILA
Other - Middle Name:JACOBA
Other - Last Name:HEERSINK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9801 DUPONT AVE S STE 425
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55431-3873
Mailing Address - Country:US
Mailing Address - Phone:952-567-6125
Mailing Address - Fax:952-567-6176
Practice Address - Street 1:8401 GOLDEN VALLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4488
Practice Address - Country:US
Practice Address - Phone:763-416-7600
Practice Address - Fax:763-416-7634
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA129482207W00000X
MN69417207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology