Provider Demographics
NPI:1780577254
Name:HEIDENREICH, DREANA
Entity type:Individual
Prefix:
First Name:DREANA
Middle Name:
Last Name:HEIDENREICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 FAIRLAWN DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60073-3114
Mailing Address - Country:US
Mailing Address - Phone:815-541-9453
Mailing Address - Fax:
Practice Address - Street 1:1 GENESYS PKWY
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-8065
Practice Address - Country:US
Practice Address - Phone:810-606-5987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5951001585211D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric