Healthcare Provider Details

I. General information

NPI: 1831194794
Provider Name (Legal Business Name): DAVID JOHN HEINE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 8TH AVE W
CRESCO IA
52136-1062
US

IV. Provider business mailing address

621 S ILLINOIS AVE STE 103
MASON CITY IA
50401-5489
US

V. Phone/Fax

Practice location:
  • Phone: 563-547-2101
  • Fax: 563-547-3448
Mailing address:
  • Phone: 641-428-3041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32063
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier946717300
Identifier TypeMEDICAID
Identifier StateMN
Identifier Issuer
# 2
Identifier1185207
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: