Provider Demographics
NPI:1922362102
Name:HEIMER, SETH WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:WILLIAM
Last Name:HEIMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3909
Mailing Address - Country:US
Mailing Address - Phone:309-300-1031
Mailing Address - Fax:309-717-0003
Practice Address - Street 1:2502 E EMPIRE ST STE C
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3739
Practice Address - Country:US
Practice Address - Phone:309-300-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125062314207Q00000X, 207Q00000X
MI5101021638207Q00000X
ARE9849207Q00000X
GA080539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine