Healthcare Provider Details

I. General information

NPI: 1508475724
Provider Name (Legal Business Name): WHOLE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2O MUSSEY ROAD SUITE 2
SCARBOROUGH ME
04074
US

IV. Provider business mailing address

2O MUSSEY ROAD SUITE 2
SCARBOROUGH ME
04074
US

V. Phone/Fax

Practice location:
  • Phone: 207-885-1333
  • Fax:
Mailing address:
  • Phone: 207-885-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIA W HEISE
Title or Position: OWNER
Credential: MD
Phone: 207-846-8722