Provider Demographics
NPI:1831194794
Name:HEINE, DAVID JOHN (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:HEINE
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 1:621 S ILLINOIS AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-5489
Mailing Address - Country:US
Mailing Address - Phone:641-428-3041
Mailing Address - Fax:
Practice Address - Street 1:235 8TH AVE W
Practice Address - Street 2:
Practice Address - City:CRESCO
Practice Address - State:IA
Practice Address - Zip Code:52136-1062
Practice Address - Country:US
Practice Address - Phone:563-547-2101
Practice Address - Fax:563-547-3448
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32063207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN946717300Medicaid
IA1185207Medicaid
IA48482Medicare ID - Type Unspecified
G35296Medicare UPIN
IA1185207Medicaid