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General NPI Number Information
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NPI Number | 1770042087
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Entity Type | Individual
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Provider Name | SETH A HEIKKILA M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2019
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Last Update Date | 07/08/2022
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Provider Practice Location Address
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Address Line | 512 SKYLINE BLVD STE 1
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City | CLOQUET
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State | MN
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Zip | 55720-1199
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Country | US
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Telephone | 218-879-4641
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Fax |
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Provider Business Mailing Address
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Address Line | 512 SKYLINE BLVD STE 1
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City | CLOQUET
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State | MN
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Zip | 55720-1199
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Country | US
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Telephone | 218-879-4641
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MED-RES-LIC-77263
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 71958
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License Number State | MN
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