Provider Demographics
NPI:1750369765
Name:HEUN, MITCHELL E (MD)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:E
Last Name:HEUN
Suffix:
Gender:M
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 8674
Mailing Address - Street 2:MANKATO CLINIC LTD
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1421 PREMIER DR
Practice Address - Street 2:MANKATO CLINIC @ WICKERSHAM CAMPUS
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-625-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46561207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0117198OtherMEDICA
IA2242628Medicaid
MNNA2951040974OtherPREFERRED ONE
MN131456OtherUCARE
410849339 56001 C216OtherCHAMPUS
MN2178704OtherAMERICAS PPO
MN252L9HEOtherBCBS
MNHP42266OtherHEALTH PARTNERS
P00218990OtherRR MEDICARE
MN892907600Medicaid
MNHP42266OtherHEALTH PARTNERS
MN2178704OtherAMERICAS PPO