Healthcare Provider Details

I. General information

NPI: 1962499582
Provider Name (Legal Business Name): DAVID CHARLES HEUSINKVELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 01/24/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4230 HARDING PIKE STE. 530 HEART INSTITUTE
NASHVILLE TN
37205-2013
US

IV. Provider business mailing address

PO BOX 504556
SAINT LOUIS MO
63150-0001
US

V. Phone/Fax

Practice location:
  • Phone: 615-297-6006
  • Fax: 615-298-6778
Mailing address:
  • Phone: 615-297-6006
  • Fax: 615-298-6778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number24306
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: