Provider Demographics
NPI:1437228749
Name:HEIKKENEN, HERMAN CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:CHARLES
Last Name:HEIKKENEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2527
Mailing Address - Street 2:ROCKY MOUNTAIN MEDICAL PLLC
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86302
Mailing Address - Country:US
Mailing Address - Phone:928-777-2425
Mailing Address - Fax:928-777-9044
Practice Address - Street 1:1003 DIVISION ST
Practice Address - Street 2:STE 1 ROCKY MOUNTAIN MEDICAL PLLC
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-777-2425
Practice Address - Fax:928-777-9044
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ32037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G23577Medicare UPIN
Z115120Medicare PIN
Z83290Medicare ID - Type Unspecified