Provider Demographics
NPI:1528188265
Name:HEINE, CARL F (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:F
Last Name:HEINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7822 DAVENPORT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3629
Mailing Address - Country:US
Mailing Address - Phone:402-391-4855
Mailing Address - Fax:402-391-6818
Practice Address - Street 1:7822 DAVENPORT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3629
Practice Address - Country:US
Practice Address - Phone:402-391-4855
Practice Address - Fax:402-391-6818
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2016-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE25126207L00000X, 207L00000X
IA38377207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE094951029OtherWPS MEDICARE