Individual
DR. HEIDI FRUTCHY DEBLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
22 BRAMHALL ST, PORTLAND, ME 04102-3175
(207) 662-4618
Mailing address
22 BRAMHALL ST, PORTLAND, ME 04102-3175
(207) 662-4618
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD22762
ME
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
188769
NY
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD22762
ME
207RP1001X
Pulmonary Disease Physician
MD22762
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01583788
—
NY
Enumeration date
10/05/2005
Last updated
02/19/2021
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