Provider Demographics
NPI:1396734927
Name:HEIKES, LARRY G (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:G
Last Name:HEIKES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19876 SAINT JOSEPH DR
Mailing Address - Street 2:CENTERVILLE MEDICAL CLINIC
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-8850
Mailing Address - Country:US
Mailing Address - Phone:641-856-8684
Mailing Address - Fax:641-856-3009
Practice Address - Street 1:19876 SAINT JOSEPH DR
Practice Address - Street 2:CENTERVILLE MEDICAL CLINIC
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-8850
Practice Address - Country:US
Practice Address - Phone:641-856-8684
Practice Address - Fax:641-856-3009
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA22165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4204495Medicaid
IAP00002281OtherRR MEDICARE
A01525Medicare UPIN
IAI8375Medicare PIN