Individual
MICHAEL HEISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1005 HEALTH CENTER DR STE 103, MATTOON, IL 61938-4693
(217) 258-4051
(217) 258-4063
Mailing address
1005 HEALTH CENTER DR STE 201, MATTOON, IL 61938-4693
(217) 238-6055
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004872
IL
Other
Enumeration date
11/08/2013
Last updated
09/24/2018
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