Provider Demographics
NPI:1215399167
Name:DR HEINLENS HEALTH CARE CLINIC PLLC
Entity Type:Organization
Organization Name:DR HEINLENS HEALTH CARE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LENE
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:HEINLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-304-1343
Mailing Address - Street 1:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:TROUT LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49793-0136
Mailing Address - Country:US
Mailing Address - Phone:989-304-1343
Mailing Address - Fax:
Practice Address - Street 1:806 N STATE ST
Practice Address - Street 2:SUITE B
Practice Address - City:STANTON
Practice Address - State:MI
Practice Address - Zip Code:48888-9708
Practice Address - Country:US
Practice Address - Phone:616-459-0898
Practice Address - Fax:616-459-6963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-21
Last Update Date:2019-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015385207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI9687Medicaid