Healthcare Provider Details

I. General information

NPI: 1255991675
Provider Name (Legal Business Name): PETER HEDDERICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 E WARWICK DR
ALMA MI
48801-1014
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-2000
US

V. Phone/Fax

Practice location:
  • Phone: 989-839-1644
  • Fax: 989-839-3029
Mailing address:
  • Phone: 989-839-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number4351045495
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4351045495
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: