Provider Demographics
NPI:1912173592
Name:HEIMAN, JOHN O'CONNOR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:O'CONNOR
Last Name:HEIMAN
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 1:4545 WORNALL RD
Mailing Address - Street 2:# 608
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3209
Mailing Address - Country:US
Mailing Address - Phone:816-716-0935
Mailing Address - Fax:
Practice Address - Street 1:4545 WORNALL RD
Practice Address - Street 2:# 608
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3270
Practice Address - Country:US
Practice Address - Phone:816-716-0935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004036765204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery