=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538279542
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARGARET MARRY PATRICIA HEISER R.D., C.D.E.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6245 INKSTER RD
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48135-4001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-421-3300
-----------------------------------------------------
Fax | 734-422-0273
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6245 INKSTER RD
-----------------------------------------------------
City | GARDEN CITY
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48135-4001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-421-3300
-----------------------------------------------------
Fax | 734-422-0273
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 133V00000X
-----------------------------------------------------
Taxonomy Name | Registered Dietitian
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------