Provider Demographics
NPI:1881788552
Name:HEINS, CRAIG L (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:L
Last Name:HEINS
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 1:1621 N TAYLOR DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-1992
Mailing Address - Country:US
Mailing Address - Phone:920-458-4419
Mailing Address - Fax:920-458-7516
Practice Address - Street 1:1621 N TAYLOR DR STE 300
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1992
Practice Address - Country:US
Practice Address - Phone:920-458-4419
Practice Address - Fax:920-458-7516
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47379020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34588000Medicaid
WI32882800Medicaid
WII20288Medicare UPIN
WI32882800Medicaid