Basic Information
| Provider Information | |||||||||
| NPI: | 1568823870 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEILIG | ||||||||
| FirstName: | DIANA | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4461 STATE ROUTE 159 | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456018620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407794900 | ||||||||
| FaxNumber: | 7407794909 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 OSBORNE RD NE STE 255 | ||||||||
| Address2: | |||||||||
| City: | FRIDLEY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554322768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7637866011 | ||||||||
| FaxNumber: | 7632362505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2016 | ||||||||
| LastUpdateDate: | 07/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 66180 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.