Provider Demographics
NPI:1477945004
Name:HEINDEL, KOAN J (DO)
Entity Type:Individual
Prefix:DR
First Name:KOAN
Middle Name:J
Last Name:HEINDEL
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:PO BOX 67070
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44222-7070
Mailing Address - Country:US
Mailing Address - Phone:330-971-7571
Mailing Address - Fax:
Practice Address - Street 1:3800 EMBASSY PKWY
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-8387
Practice Address - Country:US
Practice Address - Phone:330-971-7571
Practice Address - Fax:330-255-5093
Is Sole Proprietor?:No
Enumeration Date:2015-02-18
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00000000000000207X00000X
OH34.012592207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0448601Medicaid