Heusinkveld, Dominika Grodzicka

Heusinkveld, Dominika Grodzicka is an individual health care provider with primary practice located at 167 North Main Street , Tuba City AZ 86045-0600. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Heusinkveld, Dominika Grodzicka can be contacted via phone (928) 283-2458.

Contact Information

Primary practice address
167 North Main Street Tuba City AZ 86045-0600
Fax: (928) 283-2677
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 43843 Arizona

Profile Details

NPI number 1861483471
LBN Legal business name Heusinkveld, Dominika Grodzicka
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 2nd, 2005
Last updated Feb 17th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1861483471 NPPES
Colorado MEDICAID 09529730
Colorado MEDICAID 05686202

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