Provider Demographics
NPI:1811487366
Name:HEIM, DEVON ROBERT
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:ROBERT
Last Name:HEIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E6257 821ST AVE
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WI
Mailing Address - Zip Code:54730-4406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 OBSERVATORY DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53706-1121
Practice Address - Country:US
Practice Address - Phone:715-505-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIH500-1769-7047-072081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine