Provider Demographics
NPI:1699980367
Name:HIESTERMAN, MARK ANDREW (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:HIESTERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:16201 E INDIANA AVE
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-2830
Mailing Address - Country:US
Mailing Address - Phone:509-891-8904
Mailing Address - Fax:509-344-3104
Practice Address - Street 1:221 5TH AVE S
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2600
Practice Address - Country:US
Practice Address - Phone:406-228-3536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60226290208600000X
MT131349208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery