Provider Demographics
NPI:1538297940
Name:BRIAN J. HEINEMAN, D.O.
Entity Type:Organization
Organization Name:BRIAN J. HEINEMAN, D.O.
Other - Org Name:BROOKLYN MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEINEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:641-522-7221
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:IA
Mailing Address - Zip Code:52211-0527
Mailing Address - Country:US
Mailing Address - Phone:641-522-7221
Mailing Address - Fax:641-522-5816
Practice Address - Street 1:128 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:IA
Practice Address - Zip Code:52211
Practice Address - Country:US
Practice Address - Phone:641-522-7221
Practice Address - Fax:641-522-5816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0415489Medicaid
IACJ6924OtherRAIRLROAD MEDICARE GROUP