# DR. DOMINIKA GRODZICKA HEUSINKVELD

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1861483471
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 43843 | AZ | Yes |

## Other

- **Enumeration date:** 11/02/2005
- **Last updated:** 02/17/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 05686202 | — | NM |
| 05 | — | 09529730 | — | CO |