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General NPI Number Information
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NPI Number | 1457477408
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Entity Type | Organization
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Legal Business Name | HEIDI E MIDDENDORF MD PC
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 180 PROVIDENCE RD SUITE 5
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City | CHAPEL HILL
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State | NC
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Zip | 27514-2206
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Country | US
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Telephone | 919-493-0569
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Fax | 919-403-9101
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Provider Business Mailing Address
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Address Line | 180 PROVIDENCE RD SUITE 5
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City | CHAPEL HILL
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State | NC
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Zip | 27514-2206
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Country | US
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Telephone | 919-493-0569
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Fax | 919-403-9101
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Authorized Official
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Title or Position | PRESIDENT, OWNER
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Name | DR. HEIDI ELISE MIDDENDORF
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Credential | M.D.
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Telephone | 919-493-0569
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 39035
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License Number State | NC
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