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NPI Code Detail

MEDICARE: DR. DAVID MICHAEL HEFNER D.O.

MEDICARE: DR. DAVID MICHAEL HEFNER D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOS015131PA
2207Q00000XFamily Medicine Physician2341WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013114610
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID MICHAEL HEFNER D.O.
Provider Business Mailing Address
First Line : 215 DON KNOTTS BLVD
Second Line :
City : MORGANTOWN
State : WV
Zip : 26501-6734
Country : US
Telephone Number : 304-291-3627
Fax Number : 304-284-8667
Provider Business Practice Location Address
First Line : 16490 W 78TH ST
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55346-4300
Country : US
Telephone Number : 952-934-5332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2007
Last Update Date : 05/21/2024

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