Provider Demographics
NPI:1740253400
Name:HEYSLINGER, PAUL GARY (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:GARY
Last Name:HEYSLINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:228 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:AVON LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44012
Mailing Address - Country:US
Mailing Address - Phone:440-933-8600
Mailing Address - Fax:440-933-4613
Practice Address - Street 1:228 MILLER RD
Practice Address - Street 2:
Practice Address - City:AVON LAKE
Practice Address - State:OH
Practice Address - Zip Code:44012
Practice Address - Country:US
Practice Address - Phone:440-933-8600
Practice Address - Fax:440-933-4613
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042453H207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0394194Medicaid
0103534OtherUNITED HEALTHCARE
59218OtherQUALCHOICE
000000130348OtherANTHEM
A77960Medicare UPIN
000000130348OtherANTHEM