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
Phone: (928) 283-2458
Fax: (928) 283-2677
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1861483471 | NPPES |
| Colorado | MEDICAID | 09529730 | |
| Colorado | MEDICAID | 05686202 |
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