Organization
HEIDELBERG DERMATOLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN A. HEIDELBERG M.D. (PRESIDENT)
(313) 864-3766
Entity
Organization
Contact information
Practice address
20400 LIVERNOIS AVE, DETROIT, MI 48221-1348
(313) 341-4514
(313) 341-2152
Mailing address
20400 LIVERNOIS AVE, DETROIT, MI 48221-1348
(313) 864-3766
(313) 864-8134
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
4301066952
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0H28011
BLUE CROSS SHIELD MICHIGA
MI
Enumeration date
07/16/2006
Last updated
12/02/2015
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