Provider Demographics
NPI:1891991840
Name:GRETCHEN L. HEUTSCHE, DPM PC
Entity Type:Organization
Organization Name:GRETCHEN L. HEUTSCHE, DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEUTSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:734-994-3668
Mailing Address - Street 1:3001 PLYMOUTH RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-3205
Mailing Address - Country:US
Mailing Address - Phone:734-994-3668
Mailing Address - Fax:734-994-4088
Practice Address - Street 1:3001 PLYMOUTH RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-3205
Practice Address - Country:US
Practice Address - Phone:734-994-3668
Practice Address - Fax:734-994-4088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGH002022213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU81310Medicare UPIN
MI0N81400Medicare PIN
MI4960000001Medicare NSC