Clare B Heidtke, M.D.

Primary specialty

Gynecology PhysicianTaxonomy code 207VG0400X

License

CH045760 Issued in MI

Practice address

2810 Charlevoix Ave
Suite 104
Petoskey, MI 49770-8421

Phone

(231) 487-0970

Fax

(231) 487-0979

NPI assigned

Oct 6, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1013004373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 CHARLEVOIX AVE",
            "address_2": "SUITE 104",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708421",
            "telephone_number": "231-487-0970",
            "fax_number": "231-487-0979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 CHARLEVOIX AVE",
            "address_2": "SUITE 104",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708421",
            "telephone_number": "231-487-0970",
            "fax_number": "231-487-0979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEIDTKE",
        "first_name": "CLARE",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "MI",
            "license": "CH045760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3509689",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD MI",
            "identifier": "045760",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chris Hastings
• Janet Havens, RD, CDE
• Kyle J Hazelwood, M.D.
• Keith D Head, LMSW
• Hearing Specialists of Northern Michigan
• Vira C Heise, M.D.
• William F Heise II, M.D.
• Jacob Bradford Hekker, MSN, CRNA
• William E Henry, MD
• Lisa Hepner

• Gynecology Physician in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Gynecology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.