Provider Demographics
NPI:1144752932
Name:KNICKEL, HEEPKE JOHANNA (MD)
Entity Type:Individual
Prefix:
First Name:HEEPKE
Middle Name:JOHANNA
Last Name:KNICKEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEEPKE
Other - Middle Name:JOHANNA
Other - Last Name:WENDROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE. ML11013
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-7179
Mailing Address - Fax:513-636-8929
Practice Address - Street 1:3333 BURNET AVE. ML11013
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-7179
Practice Address - Fax:513-636-8929
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.142524208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics