Provider Demographics
NPI:1336198985
Name:HEINY, MARK E (MD, PHD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:HEINY
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8326 NAAB RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1920
Mailing Address - Country:US
Mailing Address - Phone:317-871-0000
Mailing Address - Fax:317-871-0010
Practice Address - Street 1:8326 NAAB RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1920
Practice Address - Country:US
Practice Address - Phone:317-871-0000
Practice Address - Fax:317-871-0010
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045220A2080P0207X
IN010452202080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200113750Medicaid
ING41555Medicare UPIN
IN200113750Medicaid