Provider Demographics
NPI:1548389455
Name:HEINZELMANN, ANDREW DUNSMORE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:DUNSMORE
Last Name:HEINZELMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3317 N WIMBERLY DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4056
Mailing Address - Country:US
Mailing Address - Phone:479-587-3149
Mailing Address - Fax:479-521-4603
Practice Address - Street 1:3317 N WIMBERLY DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4056
Practice Address - Country:US
Practice Address - Phone:479-521-2752
Practice Address - Fax:479-444-6942
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4659207X00000X, 207XX0005X
MS19708207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR08070023900OtherQUALCHOICE
AR5H114OtherBLUE CROSS BLUE CHEILD
AZ168677001Medicaid
AR08070023900OtherQUALCHOICE