Provider Demographics
NPI:1942584941
Name:FITE, HEIDI (PA-C)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:FITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:SZERLONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11293 N M 37
Mailing Address - Street 2:STE. A
Mailing Address - City:BUCKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49620-9593
Mailing Address - Country:US
Mailing Address - Phone:231-269-4185
Mailing Address - Fax:231-269-4461
Practice Address - Street 1:11293 N M 37
Practice Address - Street 2:STE. A
Practice Address - City:BUCKLEY
Practice Address - State:MI
Practice Address - Zip Code:49620-9593
Practice Address - Country:US
Practice Address - Phone:231-269-4185
Practice Address - Fax:231-269-4461
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6274363A00000X
MI5601007246363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1343PAMedicaid
GA003121146AMedicaid
GA003121146AMedicaid