Healthcare Provider Details

I. General information

NPI: 1700231313
Provider Name (Legal Business Name): HEATHER SAFFEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W JEFFERSON BLVD STE 100
SOUTH BEND IN
46601-1993
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-1670
  • Fax: 574-647-6927
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number01084052A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: