Healthcare Provider Details

I. General information

NPI: 1992971212
Provider Name (Legal Business Name): HEIDI ELIZABETH MONAGHAN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E WACKERLY ST STE A
MIDLAND MI
48642-7043
US

IV. Provider business mailing address

111 E WACKERLY ST STE A
MIDLAND MI
48642-7043
US

V. Phone/Fax

Practice location:
  • Phone: 989-488-6355
  • Fax:
Mailing address:
  • Phone: 989-488-6355
  • Fax: 989-486-9051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002307
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: