Provider Demographics
NPI:1164656559
Name:HEITMAN, JOEL THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:THOMAS
Last Name:HEITMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BERTRAND DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-8308
Mailing Address - Country:US
Mailing Address - Phone:810-964-1892
Mailing Address - Fax:
Practice Address - Street 1:615 S NEW BALLAS RD DEPT OF
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8221
Practice Address - Country:US
Practice Address - Phone:314-251-6031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN521552085R0202X
OH351251542085R0202X
KY477532085R0202X
MI43010950352085R0202X
MO20190424012085R0202X
IN01074617A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1164656559Medicaid
KY7100328740Medicaid
IN201255510Medicaid
TNQ012331Medicaid
OH0112227Medicaid
IN201255510Medicaid
OH0112227Medicaid