Provider Demographics
NPI:1790766194
Name:HEINDL, JOHN EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EDWARD
Last Name:HEINDL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4421 EASTGATE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-4500
Mailing Address - Country:US
Mailing Address - Phone:513-752-8000
Mailing Address - Fax:513-752-1078
Practice Address - Street 1:4421 EASTGATE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-4500
Practice Address - Country:US
Practice Address - Phone:513-752-8000
Practice Address - Fax:513-752-1078
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH2090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0196961Medicaid
A74115Medicare UPIN
0374485Medicare PIN