Provider Demographics
NPI:1023486867
Name:BRIAN D. HEERINGA PC
Entity type:Organization
Organization Name:BRIAN D. HEERINGA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEERINGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-946-1488
Mailing Address - Street 1:PO BOX 30516
Mailing Address - Street 2:DEPT 6102
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-8016
Mailing Address - Country:US
Mailing Address - Phone:231-946-1488
Mailing Address - Fax:231-946-1489
Practice Address - Street 1:880 MUNSON AVE STE A
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-3661
Practice Address - Country:US
Practice Address - Phone:231-294-6148
Practice Address - Fax:231-946-1489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty