Individual ProviderFrederick HeitjanPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansPractice Address235 Wealthy St SE, Grand Rapids, MI 49503-5247(616) 840-8000PECOS EnrollmentBased on the most recent information from CMS, provider Frederick Heitjan is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 10:10 AM.Profile DetailsProvider ID1245971225Provider TypeIndividualFull NameHeitjan, FrederickCredentialMDGenderMaleSole ProprietorNoEnumeration Date4/5/2022Last Updated8/11/2023Contact InformationPractice LocationPractice Address235 Wealthy St SE, Grand Rapids, MI 49503-5247Phone(616) 840-8000FaxUnlisted FaxMailing LocationMailing Address235 Wealthy St SE, Grand Rapids, MI 49503-5247Phone(616) 840-8000FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode208100000XPrimaryDescriptionPhysical Medicine & RehabilitationAllopathic & Osteopathic PhysiciansLicense4351050569MichiganCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer