Provider Demographics
NPI:1649219460
Name:HEINRICHS, RICHARD W (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:HEINRICHS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 HIGHWAY 59 S
Mailing Address - Street 2:
Mailing Address - City:THIEF RIVER FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56701-4331
Mailing Address - Country:US
Mailing Address - Phone:218-681-4747
Mailing Address - Fax:218-683-2595
Practice Address - Street 1:1900 BROTHER GEENEN WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7102
Practice Address - Country:US
Practice Address - Phone:941-556-3220
Practice Address - Fax:941-955-8214
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20734207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN901107OtherAMERICA'S PPO/ARAZ #
MN10239OtherNDBS #
MN142311OtherUCARE #
FMHP19488OtherHEALTHPARTNERS #
FMMN100011OtherLHS/BANNERHEALTH #
MN12958Medicaid
MN315068200Medicaid
FM0402916OtherMEDICA #
MN63328HEOtherMNBS #
MNDA9021015699OtherPREFERRED ONE #
ND10148OtherND LICENSE #
MN901107OtherAMERICA'S PPO/ARAZ #
FMHP19488OtherHEALTHPARTNERS #
MN63328HEOtherMNBS #
MN10239OtherNDBS #
MNDA9021015699OtherPREFERRED ONE #