Provider Demographics
NPI:1437292513
Name:HEILER, SHAWN MICHAEL (PA-C, ATC)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:MICHAEL
Last Name:HEILER
Suffix:
Gender:M
Credentials:PA-C, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6700 RIVES JUNCTION RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-7448
Mailing Address - Country:US
Mailing Address - Phone:517-569-3200
Mailing Address - Fax:517-569-3005
Practice Address - Street 1:6700 RIVES JUNCTION RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-7448
Practice Address - Country:US
Practice Address - Phone:517-569-3200
Practice Address - Fax:517-569-3005
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
MI5601005761363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer