| Organization Name: | BRIAN D. HEERINGA PC |
| NPI Number: | 1023486867 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRIAN D HEERINGA (OWNER/PRESIDENT) |
| Mailing Address: | 927 S Carmel St Cadillac |
| State: | MI US |
| Postal Code: | 496012547 |
| Phone Number: | 2318763876 |
| Fax Number: | 2317751115 |
| NPI Enumeration Date: | 09/10/2015 |
| NPI Last Update Date: | 10/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 4301076613 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |