Healthcare Provider Details

I. General information

NPI: 1396305140
Provider Name (Legal Business Name): KATRIN HEINEMAN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 SILVERSIDE RD STE 201
WILMINGTON DE
19810-4164
US

IV. Provider business mailing address

2106 SILVERSIDE RD STE 201
WILMINGTON DE
19810-4164
US

V. Phone/Fax

Practice location:
  • Phone: 302-478-8099
  • Fax: 302-478-8717
Mailing address:
  • Phone: 302-478-8099
  • Fax: 302-478-8717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1-0010278
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE1-0010278
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE1-0010278
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: