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General NPI Number Information
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NPI Number | 1245353853
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Entity Type | Individual
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Provider Name | DAVID J HEERINGA D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 7169 KALAMAZOO AVE SE STE 100
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City | CALEDONIA
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State | MI
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Zip | 49316
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Country | US
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Telephone | 616-266-9100
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Fax | 616-266-9200
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Provider Business Mailing Address
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Address Line | 7169 KALAMAZOO AVE SE STE 100
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City | CALEDONIA
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State | MI
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Zip | 49316-8146
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Country | US
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Telephone | 616-266-9100
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Fax | 616-266-9200
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 5101016904
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License Number State | MI
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