MEDICARE: MR. HEATH D EWING PA C

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	363AS0400X	Surgical Physician Assistant	10001509A	IN
2	363A00000X	Physician Assistant	10001509A	IN

General Provider Information

NPI Number	:	1093753766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HEATH D EWING PA C

Provider Business Mailing Address
First Line	:	PO BOX 781076
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48278-1076
Country	:	US
Telephone Number	:	317-528-4800
Fax Number	:	317-865-1479

Provider Business Practice Location Address
First Line	:	1199 HADLEY RD
Second Line	:
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-1788
Country	:	US
Telephone Number	:	317-831-2273
Fax Number	:	317-831-9347

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	04/03/2026

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