Heidelberg Dermatology, P.C.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

4301066952 Issued in MI

Legal business name

HEIDELBERG DERMATOLOGY, P.C.

Practice address

20400 Livernois Ave
Detroit, MI 48221-1348

Phone

(313) 341-4514

Fax

(313) 341-2152

NPI assigned

Jul 16, 2006

Organization subpart

No

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

Authorized official

Name

Karen A. Heidelberg, M.D.NPI 1467406439

Title

President

Phone

(313) 864-3766

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Karen Ann Heidelberg, M.D.

  • Dermatology Physician
  • Detroit, MI
  • NPI 1467406439
  Medicare reassignment Care Compare group Authorized official
• Carla Scott, MD

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1114054442
  Medicare reassignment Care Compare group NPD
• Carol Prince, M.D.

  • Dermatology Physician
  • Detroit, MI
  • NPI 1922206580
  Medicare reassignment NPD
• Carla Hunter, M.D.

  • Family Medicine Physician
  • Detroit, MI
  • NPI 1689721375
  NPD (past)

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449014400000",
    "number": "1124045075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20400 LIVERNOIS AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482211348",
            "telephone_number": "313-864-3766",
            "fax_number": "313-864-8134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20400 LIVERNOIS AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482211348",
            "telephone_number": "313-341-4514",
            "fax_number": "313-341-2152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEIDELBERG DERMATOLOGY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2015-12-02",
        "status": "A",
        "authorized_official_last_name": "HEIDELBERG",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "313-864-3766",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "MI",
            "license": "4301066952",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS SHIELD MICHIGA",
            "identifier": "0H28011",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hebah M.S. Hefzy, M.D.
• Sara Hegab
• Stephen Ogden Hegenauer, PHARMD
• Hege Finvold Heggum, M.D
• Leland Philip Hehman, R.PH.
• Karen Ann Heidelberg, M.D.
• Danielle Lynn Heidemann, MD
• Sabrina Marie Heidemann, MD
• Jacob Heikkinen
• Courtney Heilig

• Dermatology Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.