Healthcare Provider Details

I. General information

NPI: 1104076595
Provider Name (Legal Business Name): WILLIAM C. HEATH MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2008
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22341 W 8 MILE RD
DETROIT MI
48219-1217
US

IV. Provider business mailing address

22341 W 8 MILE RD
DETROIT MI
48219-1217
US

V. Phone/Fax

Practice location:
  • Phone: 313-255-4672
  • Fax:
Mailing address:
  • Phone: 313-255-4672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number036972
License Number StateMI

VIII. Authorized Official

Name: MRS. KASSANDRA HILL
Title or Position: MANAGER
Credential:
Phone: 313-255-4672