Provider Demographics
NPI:1669868402
Name:HEILBRONN, CAMERON M (MD)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:M
Last Name:HEILBRONN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21000 E 12 MILE RD STE 111
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1156
Mailing Address - Country:US
Mailing Address - Phone:586-779-7610
Mailing Address - Fax:586-779-7882
Practice Address - Street 1:21000 E 12 MILE RD STE 111
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1156
Practice Address - Country:US
Practice Address - Phone:586-779-7610
Practice Address - Fax:586-779-7882
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301501663207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology