Provider Demographics
NPI:1891796272
Name:HEINRICHS, TIMOTHY A (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:A
Last Name:HEINRICHS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 W MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:COLDWATER
Mailing Address - State:OH
Mailing Address - Zip Code:45828-1773
Mailing Address - Country:US
Mailing Address - Phone:419-763-5300
Mailing Address - Fax:419-763-5305
Practice Address - Street 1:116 W MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828-1773
Practice Address - Country:US
Practice Address - Phone:419-763-5300
Practice Address - Fax:419-763-5305
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0686913Medicaid
OH0686913Medicaid
OH0640364Medicare PIN