Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4351044191 | MI |
NPI | 1003476201 |
---|---|
Provider Name | Dr. Gerard Edward Heath |
First Address | Livonia, MI 48154-5102 |
Second Address | Detroit, MI 48202-2689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2019 |
Last Update Date | 19/06/2019 |