Provider Demographics
NPI:1619972627
Name:HEINZE, MARGARET (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:
Last Name:HEINZE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:HEINZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:212 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HAUGEN
Mailing Address - State:WI
Mailing Address - Zip Code:54841-5600
Mailing Address - Country:US
Mailing Address - Phone:715-475-1500
Mailing Address - Fax:
Practice Address - Street 1:212 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:HAUGEN
Practice Address - State:WI
Practice Address - Zip Code:54841-5600
Practice Address - Country:US
Practice Address - Phone:715-475-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI44912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34457500Medicaid
WIH98054Medicare UPIN