Provider Demographics
NPI:1548341035
Name:HEINEMAN, BRIAN J (DO)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:HEINEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:128 JACKSON STREET
Mailing Address - City:BROOKLYN
Mailing Address - State:IA
Mailing Address - Zip Code:52211-0527
Mailing Address - Country:US
Mailing Address - Phone:641-522-7221
Mailing Address - Fax:641-522-5816
Practice Address - Street 1:128 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:IA
Practice Address - Zip Code:52211
Practice Address - Country:US
Practice Address - Phone:641-522-7221
Practice Address - Fax:641-522-5816
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA01662207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA06059OtherWELLMARK BLUE CROSS
IA0415489Medicaid
IAI5182Medicare PIN
IA0415489Medicaid
IAA01355Medicare UPIN