Organization
JACK HEETHOUSE DO PLLC
Active
Organization
JACK HEETHOUSE DO PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK W HEETHOUSE DO (OWNER)
(231) 722-7245
Entity
Organization
Contact information
Practice address
1675 LEAHY ST, SUITE 120, MUSKEGON, MI 49442-5500
(231) 722-7245
(231) 722-6103
Mailing address
1675 LEAHY ST, SUITE 120, MUSKEGON, MI 49442-5500
(231) 722-7245
(231) 722-6103
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
5101012999
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4308380
—
MI
Enumeration date
09/10/2007
Last updated
11/06/2007
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