Individual
DR. JOHN JOSEPH HIESTAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2575 HAYES AVE, SUITE 1, FREMONT, OH 43420-5201
(419) 332-1551
(419) 332-1132
Mailing address
2239 AUGUSTA DR, FREMONT, OH 43420-9130
(419) 355-8208
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35-061218
OH
208000000X
Pediatrics Physician
35-061218
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000028816
ANTHEM
OH
01
—
0828699
BCMH
OH
05
—
0828699
—
OH
01
—
110049825
RAILROAD RETIREES
OH
01
—
36D067581
CLIA
OH
01
—
4269829
AETNA
OH
Enumeration date
10/04/2005
Last updated
10/29/2009
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