Provider Demographics
NPI:1215020516
Name:HEINRICH, CLIFFORD W (DO)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:W
Last Name:HEINRICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 W NORTHERN AVENUE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-6695
Mailing Address - Country:US
Mailing Address - Phone:602-347-0873
Mailing Address - Fax:602-246-1980
Practice Address - Street 1:2211 E HIGHLAND AVENUE
Practice Address - Street 2:#105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4833
Practice Address - Country:US
Practice Address - Phone:602-954-1502
Practice Address - Fax:602-954-1504
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3295207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ27613Medicare ID - Type Unspecified
G94257Medicare UPIN