MEDICARE: HEIDI S PUC M.D.

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
1	208D00000X	General Practice Physician	182847	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1013996545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI S PUC M.D.

Provider Business Mailing Address
First Line	:	1386 STATE ROUTE 5 STE 203
Second Line	:
City	:	CHITTENANGO
State	:	NY
Zip	:	13037-8763
Country	:	US
Telephone Number	:	315-741-5774
Fax Number	:	315-741-5770

Provider Business Practice Location Address
First Line	:	1386 STATE ROUTE 5 STE 203
Second Line	:
City	:	CHITTENANGO
State	:	NY
Zip	:	13037-8763
Country	:	US
Telephone Number	:	315-741-5774
Fax Number	:	315-741-5770

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	10/01/2018

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Directions to “ HEIDI S PUC M.D.” Practice Location

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