Provider Demographics
NPI:1740213685
Name:HEISE, JULIE W (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:W
Last Name:HEISE
Suffix:
Gender:F
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:PO BOX 843018
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3018
Mailing Address - Country:US
Mailing Address - Phone:913-782-2292
Mailing Address - Fax:913-782-2381
Practice Address - Street 1:20375 W 151ST ST
Practice Address - Street 2:SUITE 306
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-5306
Practice Address - Country:US
Practice Address - Phone:913-782-2292
Practice Address - Fax:913-782-2381
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108086207L00000X
KS0428771207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202996088Medicaid
KSP00455419OtherRAILROAD
KS100177130CMedicaid
KS100177130DMedicaid
KS100177130CMedicaid
MO202996088Medicaid
KS111031001Medicare PIN
KS363000016Medicare PIN