Provider Demographics
NPI:1548214349
Name:EIMERMANN, HEIDI M (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:M
Last Name:EIMERMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 UNIVERSITY AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2167
Mailing Address - Country:US
Mailing Address - Phone:608-333-1663
Mailing Address - Fax:
Practice Address - Street 1:3330 UNIVERSITY AVE STE 205
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2167
Practice Address - Country:US
Practice Address - Phone:608-333-1663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37468-020207Q00000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32260700Medicaid
WI5318OtherDEAN HEALTH INSURANCE
G31610Medicare UPIN
WI080090100Medicare PIN
WI5318OtherDEAN HEALTH INSURANCE