Individual
DR. JACK HEETHOUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1400 MERCY DR., SUITE 100, MUSKEGON, MI 49444
(231) 733-1326
(231) 733-5212
Mailing address
1400 MERCY DR., SUITE 100, MICHIGAN, MI 49444
(231) 733-1326
(231) 733-5212
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
5101012999
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4308380
—
MI
Enumeration date
05/11/2006
Last updated
11/13/2012
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