Individual
MATTHEW E HIESTAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10724 STATE ROUTE 212 NE, BOLIVAR, OH 44612-8740
(330) 874-7165
(330) 874-7166
Mailing address
6046 WHIPPLE AVE NW, NORTH CANTON, OH 44720-7616
(330) 874-7165
(330) 874-7166
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35070029H
OH
208000000X
Pediatrics Physician
35-070029
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2066473
—
OH
Enumeration date
03/14/2006
Last updated
02/17/2012
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