Basic Information
| Provider Information | |||||||||
| NPI: | 1609876127 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BITTNER | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1100 | ||||||||
| Address2: | |||||||||
| City: | DEVILS LAKE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 583011100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7016622157 | ||||||||
| FaxNumber: | 7016624116 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 7TH ST NE | ||||||||
| Address2: | |||||||||
| City: | DEVILS LAKE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 583012719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7016622157 | ||||||||
| FaxNumber: | 7016624116 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2005 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 6415 | ND | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 17298 | 05 | ND | MEDICAID |