Provider Demographics
NPI:1730143785
Name:HEINING, TRAVIS JOHN (MD)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:JOHN
Last Name:HEINING
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 1:4300 MARKETPOINTE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5435
Mailing Address - Country:US
Mailing Address - Phone:952-767-4574
Mailing Address - Fax:
Practice Address - Street 1:4500 MARKETPOINTE DRIVE SUITE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55435-5435
Practice Address - Country:US
Practice Address - Phone:952-767-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86894207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A868940OtherBLUE SHIELD
CA00A868940Medicaid
CAP00266926OtherRAILROAD MEDICARE
CA00A868940Medicaid
CA00A868940OtherBLUE SHIELD
CAP00266926OtherRAILROAD MEDICARE