Individual
GARY MARK HEIFNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
878 AIRPORT RD, MENASHA, WI 54952-1461
(920) 727-5982
Mailing address
878 AIRPORT RD, MENASHA, WI 54952-1461
(920) 727-5982
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23080
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30438200
—
WI
Enumeration date
09/13/2005
Last updated
09/04/2008
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