Provider Demographics
NPI:1689907628
Name:BIEDEBACH, HEIDI MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:MARIE
Last Name:BIEDEBACH
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 47
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92315-0047
Mailing Address - Country:US
Mailing Address - Phone:760-987-5613
Mailing Address - Fax:760-297-2146
Practice Address - Street 1:580 THRUSH DRIVE
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315-0047
Practice Address - Country:US
Practice Address - Phone:760-987-5613
Practice Address - Fax:760-297-2146
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE72559208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice