Provider Demographics
NPI:1104918341
Name:HEIL, MARK STEVEN (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:HEIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3507 ROUND LAKE BLVD NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-5001
Mailing Address - Country:US
Mailing Address - Phone:763-323-4855
Mailing Address - Fax:763-427-4822
Practice Address - Street 1:3507 ROUND LAKE BLVD NW
Practice Address - Street 2:SUITE 300
Practice Address - City:ANOKA
Practice Address - State:MN
Practice Address - Zip Code:55303-5001
Practice Address - Country:US
Practice Address - Phone:763-323-4855
Practice Address - Fax:763-427-4822
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN4C686HEOtherBLUE CROSS BLUE SHIELD