Provider Demographics
NPI:1083804546
Name:HEINRICH, PENNY LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:PENNY
Middle Name:LOUISE
Last Name:HEINRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-339-3551
Mailing Address - Fax:
Practice Address - Street 1:500 E MARKET ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245-2633
Practice Address - Country:US
Practice Address - Phone:319-339-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-51633207R00000X, 207RH0003X
LAMD.202560207R00000X
GA067349207RH0003X
FLME111369207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208150701Medicaid
LA1239054Medicaid
GA003123030AMedicaid
FL014828000Medicaid
AR180052001Medicaid
TX208150701Medicaid
AR180052001Medicaid