Provider Demographics
NPI:1487722690
Name:GULLETT, HEIDI LYNELLE DUFF (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:LYNELLE DUFF
Last Name:GULLETT
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11100 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-1716
Mailing Address - Country:US
Mailing Address - Phone:216-844-3944
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27309207Q00000X
TN42890207Q00000X
OH093903207Q00000X, 2083P0901X
KY41451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY41451OtherKY LIC
OHP01013336OtherMEDICARE RAILROAD
TN3000971OtherCIGNA MEDICARE
OH2980190Medicaid
TN30009711OtherCIGNA MEDICARE
ORMD27309OtherOREGON LICENSE
KY0297023OtherADMINISTAR
OH35-093903OtherOHIO MEDICAL LICENSE
TN42890OtherTN LICENSE
TN42890OtherTN LICENSE
OHFG0636982OtherDEA
OH2980190Medicaid