Provider Demographics
NPI:1932144045
Name:HEFT, TADD A (DO)
Entity Type:Individual
Prefix:DR
First Name:TADD
Middle Name:A
Last Name:HEFT
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 1:1867 126TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MI
Mailing Address - Zip Code:49328-9610
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 W HIGH ST
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-1943
Practice Address - Country:US
Practice Address - Phone:269-783-3082
Practice Address - Fax:269-783-3044
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010902207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1932144045Medicaid
MI1932144045Medicaid
MIE49632Medicare UPIN
MIMI1609040Medicare PIN