Provider Demographics
NPI:1497773592
Name:HEINS, JOANNE L (MD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:L
Last Name:HEINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:L
Other - Last Name:PONTIOUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:900 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-3114
Mailing Address - Country:US
Mailing Address - Phone:715-346-5000
Mailing Address - Fax:
Practice Address - Street 1:900 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-3114
Practice Address - Country:US
Practice Address - Phone:715-346-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45426207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI45426OtherWI STATE LICENSE
WI34672200Medicaid
WI500080010Medicare ID - Type Unspecified
WI34672200Medicaid
WI002380258Medicare PIN
WI023044155Medicare PIN