Provider Demographics
NPI:1194740118
Name:HEISLER, SIDNEY (MD)
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:
Last Name:HEISLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15209 W MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-9570
Mailing Address - Country:US
Mailing Address - Phone:269-781-9119
Mailing Address - Fax:
Practice Address - Street 1:15209 W MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-9570
Practice Address - Country:US
Practice Address - Phone:269-781-9119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010552202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104699766Medicaid
MI7509107630OtherBLUE CROSS BLUE SHIELD
MIC90073Medicare UPIN
MI0A37669Medicare PIN