Provider Demographics
NPI:1851513097
Name:HEATH, WILLIAM J (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:HEATH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LAKEVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48850-9806
Mailing Address - Country:US
Mailing Address - Phone:989-352-6474
Mailing Address - Fax:
Practice Address - Street 1:418 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAKEVIEW
Practice Address - State:MI
Practice Address - Zip Code:48850-9806
Practice Address - Country:US
Practice Address - Phone:989-352-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001864363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0855900995OtherBCBS
MIE96010078Medicare PIN
MI0855900995OtherBCBS
MIH49010Medicare UPIN
MI0P08190Medicare PIN