Provider Demographics
NPI:1689262446
Name:HEIMDAHL, PETER D II
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:D
Last Name:HEIMDAHL
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 ALEX LN
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7961
Mailing Address - Country:US
Mailing Address - Phone:617-785-6141
Mailing Address - Fax:
Practice Address - Street 1:2424 MONETARY BLVD STE 12
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8736
Practice Address - Country:US
Practice Address - Phone:617-785-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care