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General NPI Number Information
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NPI Number | 1821085952
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Entity Type | Individual
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Provider Name | JOHN JOSEPH HIESTAND M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 2575 HAYES AVE SUITE 1
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City | FREMONT
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State | OH
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Zip | 43420-5201
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Country | US
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Telephone | 419-332-1551
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Fax | 419-332-1132
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Provider Business Mailing Address
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Address Line | 2239 AUGUSTA DR
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City | FREMONT
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State | OH
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Zip | 43420-9130
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Country | US
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Telephone | 419-355-8208
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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 | 35-061218
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35-061218
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License Number State | OH
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