MEDICARE: MRS. AMY LYNN HENEISEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	01049007A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265407357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY LYNN HENEISEN M.D.

Provider Business Mailing Address
First Line	:	8607 ABERDEENSHIRE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46259-7749
Country	:	US
Telephone Number	:	317-862-3401
Fax Number	:

Provider Business Practice Location Address
First Line	:	8607 ABERDEENSHIRE CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46259-7749
Country	:	US
Telephone Number	:	317-862-3401
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	05/23/2025

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