Provider Demographics
NPI:1689676793
Name:HEYSE, PAUL F (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:F
Last Name:HEYSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4649 SCHRUBB DR
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1984
Mailing Address - Country:US
Mailing Address - Phone:937-296-0300
Mailing Address - Fax:
Practice Address - Street 1:30 E APPLE ST STE 6252
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-6060
Practice Address - Fax:937-208-6061
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043188208600000X
OH35043188H2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0420413Medicaid
OH0420413Medicaid
OHA82398Medicare UPIN