Provider Demographics
NPI:1962509349
Name:HEIDEL, PAUL A (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:HEIDEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12251 JAMES ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-9675
Mailing Address - Country:US
Mailing Address - Phone:616-494-5548
Mailing Address - Fax:616-393-5643
Practice Address - Street 1:12251 JAMES ST
Practice Address - Street 2:SUITE 400
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424
Practice Address - Country:US
Practice Address - Phone:616-494-5548
Practice Address - Fax:616-393-5643
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010294192083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4363112Medicaid
MI4363121Medicaid
MI4363130Medicaid
MI4363140Medicaid
MI4363140Medicaid