Healthcare Provider Details

I. General information

NPI: 1740253400
Provider Name (Legal Business Name): PAUL GARY HEYSLINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 MILLER RD
AVON LAKE OH
44012
US

IV. Provider business mailing address

228 MILLER RD
AVON LAKE OH
44012
US

V. Phone/Fax

Practice location:
  • Phone: 440-933-8600
  • Fax: 440-933-4613
Mailing address:
  • Phone: 440-933-8600
  • Fax: 440-933-4613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35042453H
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: