Provider Demographics
NPI:1902864903
Name:CLOSE, HEIDI LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LOUISE
Last Name:CLOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:105 VALLEY WEST DR
Mailing Address - Street 2:STE 100
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-3902
Mailing Address - Country:US
Mailing Address - Phone:515-223-4368
Mailing Address - Fax:515-453-2368
Practice Address - Street 1:405 MONROE ST
Practice Address - Street 2:STE A
Practice Address - City:PELLA
Practice Address - State:IA
Practice Address - Zip Code:50219-1189
Practice Address - Country:US
Practice Address - Phone:641-628-9500
Practice Address - Fax:641-628-9701
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2015-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA33550207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA9678724Medicaid
IA9678724Medicaid
H20967Medicare UPIN