Provider Demographics
NPI:1013996545
Name:PUC, HEIDI S (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:S
Last Name:PUC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1386 STATE ROUTE 5 STE 203
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-8763
Mailing Address - Country:US
Mailing Address - Phone:315-741-5774
Mailing Address - Fax:315-741-5770
Practice Address - Street 1:1386 STATE ROUTE 5 STE 203
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-8763
Practice Address - Country:US
Practice Address - Phone:315-741-5774
Practice Address - Fax:315-741-5770
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182847208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01563675Medicaid
NYBB4929Medicare PIN