MEDICARE: GREGORY THOMAS HEINEN MD

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	207X00000X	Orthopaedic Surgery Physician	G081061	CA
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	G81061	CA

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	:	1962447961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY THOMAS HEINEN MD

Provider Business Mailing Address
First Line	:	301W HUNTINGTON DR 617
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-1518
Country	:	US
Telephone Number	:	626-574-9745
Fax Number	:	626-574-8741

Provider Business Practice Location Address
First Line	:	301W HUNTINGTON DR 617
Second Line	:
City	:	ARCADIA
State	:	CA
Zip	:	91007-1518
Country	:	US
Telephone Number	:	626-574-9745
Fax Number	:	626-574-8741

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	06/27/2024

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