Healthcare Provider Details

I. General information

NPI: 1831312768
Provider Name (Legal Business Name): MEREDITH C HEISEY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 PATIENT CARE DR
LANSING MI
48911-4217
US

IV. Provider business mailing address

3404 PATIENT CARE DR
LANSING MI
48911-4217
US

V. Phone/Fax

Practice location:
  • Phone: 517-267-0200
  • Fax: 517-267-1877
Mailing address:
  • Phone: 517-267-0200
  • Fax: 517-267-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number5101015149
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: