Provider Demographics
NPI:1821664657
Name:HEINDL, STACEY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:ELIZABETH
Last Name:HEINDL
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 1:2200 JEFFERSON AVE. MERCY HEALTH
Mailing Address - Street 2:FAMILY MEDICINE RESIDENCY OFFICES
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604
Mailing Address - Country:US
Mailing Address - Phone:419-251-1859
Mailing Address - Fax:419-242-9806
Practice Address - Street 1:2200 JEFFERSON AVE. MERCY FAMILY MEDICINE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604
Practice Address - Country:US
Practice Address - Phone:419-241-1400
Practice Address - Fax:419-251-1797
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2022-12-07
Deactivation Date:2022-11-28
Deactivation Code:
Reactivation Date:2022-12-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program