Provider Demographics
NPI:1427095124
Name:HEIDEMANN, SABRINA MARIE (MD)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:MARIE
Last Name:HEIDEMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 ST ANTOINE UHC 5D SUITE 226
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-966-2064
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:CHILDRENS HOSPITAL MI CRITICAL CARE MED
Practice Address - Street 2:3901 BEAUBIEN 4TH FLOOR - CARL'S BUILDING
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301049791208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics