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HEIDI WALLOUR MD
NPI 1114712874
Student in an Organized Health Care Education/Training Program in Detroit, MI

Active since April 14, 2025PECOS Enrolled
3990 JOHN R, SUITE 615 HARPER PROFESSIONAL BUILDING, DETROIT, MI 48201(313) 745-4195 Get Directions Write a Review

NPPES record last updated: April 14, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Heidi Wallour Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HEIDI WALLOUR MD (NPI 1114712874) is an individual student in an organized health care education/training program in Detroit, Michigan and active in the NPI registry since April 2025. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1114712874
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameHEIDI WALLOURCredential: MD
Location Address3990 JOHN R, SUITE 615 HARPER PROFESSIONAL BUILDINGDetroit, MI 48201
Mailing Address4201 St. Antoine, Uhc 9cDetroit, MI 48201
Phone(313) 745-4195
Sole ProprietorNo
Enumeration DateApril 14, 2025
NPPES CertifiedApril 14, 2025
✔ NPI 1114712874 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
3990 JOHN R, Detroit, MI 48201
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Heidi Wallour Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

YORAM SOROKIN M.D.
Obstetrics & Gynecology
3990 JOHN R, 7 BRUSH NORTH, BOX 163
DETROIT, MI 48201
Wayne County (313) 993-1388
DR. AZZA MOHAMED ALI MD
Internal Medicine (Rheumatology)
3990 JOHN R
DETROIT, MI 48201
Wayne County (313) 745-7590
DR. JOEL FREDERICK M.D.
Anesthesiology
3990 JOHN R, ANESTHESIA EDUCATION OFFICES 2901
DETROIT, MI 48201
Wayne County (313) 745-7233
DR. DONGPING SHI M.D.
Pathology (Anatomic Pathology)
3990 JOHN R
DETROIT, MI 48201
Wayne County (313) 745-8555
JASPREET SANGHA M.D
Anesthesiology (Critical Care Medicine)
3990 JOHN R, ANESTHESIOLOGY DEPTMT, BOX 162, ROOM 2901
DETROIT, MI 48201
Wayne County (313) 745-7233
MS. MERCEDES KATHERINE BROUSSEAU CRNA
Nurse Anesthetist, Certified Registered
3990 JOHN R, HARPER UNIVERSITY HOSPITAL
DETROIT, MI 48201
Wayne County (313) 745-8521
MR. DAVY BRUNO MACHADO M.D.
Student in an Organized Health Care Education/Training Program
3990 JOHN R, DEPARTMENT OF SURGERY
DETROIT, MI 48201
Wayne County (313) 577-5009

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Heidi Wallour's NPI number?

The NPI number for Heidi Wallour is 1114712874. It was assigned to this individual provider in the NPPES registry on April 14, 2025.

Where is Heidi Wallour located?

Heidi Wallour practices at 3990 John R Suite 615 Harper Professional Building, Detroit, MI 48201. The listed phone number is (313) 745-4195.

What is Heidi Wallour's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Heidi Wallour enrolled in Medicare?

Yes. Heidi Wallour is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Heidi Wallour was last updated on April 14, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.