Provider Demographics
NPI:1689761736
Name:HEINZEN, ERIK C (PA)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:C
Last Name:HEINZEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-861-2663
Mailing Address - Fax:303-861-4741
Practice Address - Street 1:2055 HIGH ST
Practice Address - Street 2:#130
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-5504
Practice Address - Country:US
Practice Address - Phone:303-861-2663
Practice Address - Fax:303-861-4741
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2013-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO2030363AS0400X
WY489363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1689761736Medicaid
WY125465100Medicaid
CO00774545Medicaid
KS200743780AMedicaid
COCOA108371Medicare PIN
SD1689761736Medicaid