Provider Demographics
NPI:1215037569
Name:HEIKENEN, JANICE B (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:B
Last Name:HEIKENEN
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 1:6287 LAGOON LANE
Mailing Address - Street 2:BOX 439
Mailing Address - City:MOHAWK
Mailing Address - State:MI
Mailing Address - Zip Code:49950-0439
Mailing Address - Country:US
Mailing Address - Phone:906-289-4316
Mailing Address - Fax:
Practice Address - Street 1:6287 LAGOON LANE
Practice Address - Street 2:BOX 439
Practice Address - City:MOHAWK
Practice Address - State:MI
Practice Address - Zip Code:49950
Practice Address - Country:US
Practice Address - Phone:906-289-4316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI325802080P0206X
MI43010893692080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI700C610000OtherBCBS OF MI
MI5345324Medicaid
WI31957600Medicaid
MI700C610000OtherBCBS OF MI
F64981Medicare UPIN
M31750029Medicare Oscar/Certification