Healthcare Provider Details

I. General information

NPI: 1689676793
Provider Name (Legal Business Name): PAUL F HEYSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST STE 6252
DAYTON OH
45409-2939
US

IV. Provider business mailing address

4649 SCHRUBB DR
KETTERING OH
45429-1984
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6060
  • Fax: 937-208-6061
Mailing address:
  • Phone: 937-296-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35043188
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35043188H
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: